Baylor University Medical Center Proceedings July 2017 - 289

Pregnancy with concomitant pancreatic cancer
Öner Aynıog˘lu, MD, Rahime Nida Ergin, MD, Yig˘it Çakırog˘lu, MD, and Eray Çalıs¸kan, MD

We report a rare case of pregnancy with concomitant pancreatic cancer.
At 28 weeks' gestation, the patient was diagnosed with a large tumoral mass in the head of the pancreas. She had a cesarean section at
32 weeks' gestation due to premature labor and underwent surgery for
pancreatic cancer in her third month postpartum.

P

ancreatic cancer is the fourth leading cancer in all age
groups and for both sexes, with an incidence of 11%
in women and 14% in men and a 5-year survival rate
of 8% (1). Its incidence peaks beyond the ﬁfth decade
(1). Cases of pancreatic cancer during pregnancy have been
very rarely reported (2-8). We report a case of pregnancy with
concomitant pancreatic cancer.
CASE PRESENTATION
A 36-year-old multiparous white obese pregnant woman
was admitted to the emergency department with complaints of
recurrent severe abdominal pain radiating to the back, jaundice,
nausea, and vomiting. She was 28 weeks pregnant according to
her last menstruation date and fetal ultrasonographic evaluation.
She had a history of two vaginal healthy term deliveries. Her
body mass index was 30.6 kg/m2. She was receiving subcutaneous insulin treatment for diabetes mellitus for 1 year. She was
an active smoker for the last 5 years, smoking half to one pack
of cigarettes per day.
Initial laboratory values indicated elevated liver function
tests: aspartate aminotransferase, 66 IU/L (normal < 45); alanine aminotransferase, 86 IU/L (normal < 45); total bilirubin,
1.5 g/dL (normal < 1.2); direct bilirubin, 0.7 g/dL (normal
< 0.4); alkaline phosphatase, 416 U/L (normal < 120); and
gamma-glutamyl transpeptidase, 286 U/L (normal < 45). Her
amylase level (23 U/L, normal < 85) and lipase level (142 U/L,
normal <160) were within normal limits. Abdominal ultrasonography revealed dilation in the intrahepatic bile ducts and
hydropic gallbladder. Tumor markers were within normal limits,
except carbohydrate antigen 19-9 (232 U/mL, normal < 37).
Advanced radiological studies, including magnetic resonance imaging and magnetic resonance cholangiopancreatography, revealed a pancreatic multilobulated mass (60 × 70 mm)
mostly located in the head and extending to the tail of the
Proc (Bayl Univ Med Cent) 2017;30(3):289-290

Figure 1. Magnetic resonance imaging of the abdomen showing a mass (*) in
the head of the pancreas.

pancreas, causing compression of the common bile duct, dilation in the intrahepatic bile ducts, and hydropic gallbladder
(Figure 1). A gastroscopy was performed, demonstrating a fragile
ulcerated polypoid mass constricting lumen in the ampulla.
Histopathological examination was reported as cytokeratin-7
positive adenocarcinoma. Consultants from general surgery and
medical oncology were brought in. Due to the patient's preference to avoid oncological intervention before giving birth to a
term baby, she was scheduled for tumoral resection and adjuvant
chemotherapy after birth.
At the 30th gestational week, a threat of premature labor
was managed with low-dose intravenous ritodrine. She was
given betamethasone treatment for 2 weeks to promote fetal
lung maturation. At the 32nd gestational week, cesarean section
From the Department of Obstetrics and Gynecology, Bülent Ecevit University
Faculty of Medicine, Zonguldak, Turkey (Aynıog˘lu); Department of Obstetrics
and Gynecology, Bahçes¸ ehir University Faculty of Medicine, Istanbul, Turkey
(Ergin, Çalıs¸kan); and Department of Obstetrics and Gynecology, Kocaeli University
Faculty of Medicine, Kocaeli, Turkey (Çakırog˘lu).
Corresponding author: Rahime Nida Ergin, MD, Defne Apt no:140, D:5 Feneryolu
Kadıköy, Istanbul, Turkey (e-mail: drnidaergin@gmail.com).
289
Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017
