title: Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy.
abstract: The prognosis of gastric cancer during pregnancy is unfavorable because of delayed diagnosis and advanced stage. We present a case of gastric carcinoma metastasized to the placenta and uterus during pregnancy. Pathological examination revealed a poorly differentiated adenocarcinoma of the stomach with lymph node metastasis. After counseling, the patient decided to terminate the pregnancy and begin immediate treatment for gastric cancer. Hysterectomy and subtotal hysterectomy were performed because medical termination of the pregnancy was unsuccessful. Pathological examination of the placenta and uterus revealed metastases of gastric adenocarcinoma. All the uterine vessels were packed with tumor cells and the myometrium showed extensive coagulative necrosis. Moreover, microscopic findings of the placenta were consistent with massive perivillous fibrin deposition. Our case clearly suggests that massive perivillous fibrin deposition in the placenta can be associated with malignancy during pregnancy and that uterine metastasis of maternal malignancy may result in myometrial dysfunction unresponsive to uterotonics.
authors.affiliation: Department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea.
authors.forename: Bada
authors.initials: B
authors.lastname: Jeong
authors.forename: Jae-Yoon
authors.initials: JY
authors.lastname: Shim
authors.forename: Chong Jai
authors.initials: CJ
authors.lastname: Kim
authors.forename: Hye-Sung
authors.initials: HS
authors.lastname: Won
authors.forename: Pil Ryang
authors.initials: PR
authors.lastname: Lee
authors.forename: Ahm
authors.initials: A
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000556:secondary; D000328:Adult; D002824:Chorionic Villi / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D006801:Humans; D009336:Necrosis; D009363:Neoplasm Proteins / Q000378:metabolism; D010920:Placenta / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology; D021041:Placental Circulation; D011247:Pregnancy; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology; D018245:Trophoblastic Tumor, Placental Site / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000556:secondary; D015854:Up-Regulation; D014594:Uterine Neoplasms / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000556:secondary; D014599:Uterus / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology
chemical_list: D009363:Neoplasm Proteins; D005337:Fibrin
keywords: gastric cancer; metastasis; perivillous fibrin deposition; pregnancy