A 36-Year-Old Pregnant Woman With Newly Diagnosed Adenocarcinoma

(N Engl J Med. 2018;379:1562–1570) A 36-year-old pregnant woman was evaluated at 33 weeks gestation because of newly diagnosed adenocarcinoma. At 32 weeks’ admission, the patient had presented to another hospital with a history of 3 days of nonradiating, severe pain accompanied by nausea in her lower back that rated 10 on a scale of 10 and originated in the epigastric region and migrated to the upper right quadrant and lower back. On examination, there was tenderness in the right upper quadrant. The gravid uterus was soft, and no abnormal fetal findings were observed. An incidental finding of renal ultrasonography showed the liver to be diffusely heterogenous and nodular, and to contain numerous masses. Abdominal magnetic resonance imaging without contrast revealed multiple lesions in the liver, some with central necrosis and with the largest being 7.4×3.9 cm. Computed tomography also revealed multiple hypoattenuating hepatic lesions, with the largest measuring 8.2 cm in diameter, with the presence of multiple enlarged periaortic and portocaval lymph nodes. Percutaneous liver biopsy revealed metastatic adenocarcinoma, poorly differentiated with widespread involvement of the liver and lymph nodes. Plans for chemotherapy and early fetal delivery were discussed with the patient, but at 32 weeks’ gestation, the patient left the first hospital because she thought her pain was undertreated and she and her spouse wanted to identify the primary cancer, understand treatmen...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Case Reports Source Type: research