Virilisation during Pregnancy in a Patient with Metastatic Colorectal Cancer

Abstract

This paper describes the case of a 25-year-old woman with virilisation occurring during pregnancy in the presence of metastatic colorectal cancer. Virilisation during pregnancy is rare. The potential causes include adrenal, foetal, or ovarian pathologies. The most common causes during pregnancy are pregnancy luteoma and hyperreactio luteinalis. The incidence of cancer during pregnancy is rare and the incidence of colorectal cancer (CRC) in pregnancy is even rarer. The presenting signs and symptoms of CRC can be confused with symptoms commonly encountered during pregnancy, thereby delaying diagnosis and commencement of treatment. Diagnosis and staging also proves more problematic in the pregnant patient as the usual modalities of colonoscopy with biopsy and imaging with CT are relatively contraindicated. Treatment is dependent on gestational age of the foetus. There is currently no agreed best practice as to the role of prophylactic oophorectomy in the prevention of metachronous ovarian metastases. Surgical and adjuvant treatments have implications for females of child-bearing age.

Antenatal diagnosis and management of pregnancy luteoma: A case report and literature review

“…Although gastrointestinal endoscopies have not been mentioned in other case studies, we believe that this method is advantageous given past instances where gastrointestinal neoplasms were mistakenly diagnosed as pregnancy luteomas. [30][31][32][33] Additionally, utilizing gastrointestinal endoscopy for diagnostic purposes continues to be a secure procedure during gestation. [34] The etiology of pregnancy luteomas remains unknown.…”

Colorectal cancer in pregnancy: a case report and literature review

“…The tumor itself is not an indication for cesarean section. When a CRC patient undergoes a cesarean section, surgical treatment can be performed at the same time during the cesarean section, or it can be performed a few weeks after the uterus regenerates and the pelvic congestion improves (3,9). All conservative treatments and delayed surgery must be fully communicated with patients and their families to inform them of the possibility of disease progression.…”

“…Possible complications include fetal growth restriction and premature delivery. When the condition permits, most researchers recommend postpartum chemotherapy (9,10). For advanced and metastatic CRC, FOLFOX [oxaliplatin, leucovorin, and 5-fluorouracil (5-FU)] regimen chemotherapy is recommended..…”