title: Combined chemotherapy and teratogenicity.
abstract: BACKGROUND
  The concomitant occurrence of breast cancer and pregnancy is relatively uncommon. We report the case of a patient with syndactyly, cleft hands, and absence of distal finger phalanges associated with maternal exposure to chemotherapeutic agents during the first trimester of pregnancy. These associations have not been previously described.
  
  
  METHODS
  The patient was born by normal delivery after 38 weeks of pregnancy. His mother became pregnant while receiving chemotherapy (cyclophosphamide, 5-fluorouracil, and adriamycin) for breast cancer, and the fetus was exposed to these drugs from conception to the 16th week of pregnancy. At birth, anomalies were observed, including a high-arched palate, microcephaly, a flat nasal bridge, bilateral syndactyly in the first and second fingers with a hand cleft between the second and third fingers and hypoplasia of the fifth fingers, and dystrophic nail of the fourth finger of the left hand. The patient's growth and development were deficient.
  
  
  CONCLUSIONS
  The malformations associated with in utero exposure to these chemotherapeutic agents are highly variable, but growth deficiency and anomalies of the craniofacial region and limbs are the most common. The pattern of malformations in children who were congenitally exposed to chemotherapeutic agents appears to be directly related to the age at and duration of exposure, rather than to the specific drug itself. Effective contraception is essential for the safe use of a potential teratogen in nonpregnant women of reproductive age.
authors.affiliation: Disciplina de Genética Clínica e Programa de Pós-Graduação em Patologia, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil. paskulin@fffcmpa.tche.br
authors.forename: Giorgio Adriano
authors.initials: GA
authors.lastname: Paskulin
authors.forename: Paulo Ricardo
authors.initials: PR
authors.lastname: Gazzola Zen
authors.forename: Louise Lapagesse
authors.initials: LL
authors.lastname: de Camargo Pinto
authors.forename: Rafael
authors.initials: R
authors.lastname: Rosa
authors.forename: Carla
authors.initials: C
authors.lastname: Graziadio
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D000015:Abnormalities, Multiple / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000633:toxicity; D000964:Antimetabolites, Antineoplastic / Q000633:toxicity; D018906:Antineoplastic Agents, Alkylating / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000633:toxicity*; D001943:Breast Neoplasms / Q000188:drug therapy*; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000633:toxicity; D002658:Developmental Disabilities / Q000139:chemically induced; D004317:Doxorubicin / Q000633:toxicity; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000633:toxicity; D006801:Humans; D008297:Male; D008431:Maternal-Fetal Exchange / Q000187:drug effects; D008831:Microcephaly / Q000139:chemically induced; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000209:etiology; D011263:Pregnancy Trimester, Third; D011859:Radiography; D013576:Syndactyly / Q000000981:diagnostic imaging / Q000209:etiology; D013723:Teratogens / Q000633:toxicity*
chemical_list: D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D013723:Teratogens; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil