Baylor University Medical Center Proceedings July 2017 - 290

Table 1. Previously reported cases of pancreatic cancer in pregnant women,
all involving the head of the pancreas
Died (months
Tumor
CA 19-9
Gestation at
Gestation at
Age of
after
admission cesarean section measurement mass size
pregnant
Reference
delivery)
(mm)
(U/mL)
(weeks)
(weeks)
woman (years)
number
2

40

24

28

4309

35 × 25a

-

+ (6)

3

32

17

-

-

20a

4

37

22

-

-

50 × 40a

+ (1)

5

38

27

28

240

40a

+ (1.7)
+ (3)

6

37

24

32

-

40a

7

32

34

34

4750

110 × 90b

0

4750

-c

0

8

32

30

34

factors for pancreatic cancer and
were present in our case (12).
Approximately 50% of patients
with pancreatic cancer have diagnosed diabetes mellitus (13). The
median duration between a diagnosis of diabetes mellitus and subsequent pancreatic cancer is 6.5
months (13). The risk of pancreatic cancer is highest among those
with recent-onset diabetes and/or
those with recent initiation of insulin therapy, as occurred in our
case (14).

aAdenocarcinoma.

1.

bMucinous

cystic neoplasm.
papillary-mucinous tumor.
CA indicates carbohydrate antigen; -, no information.
cIntraductal

was performed because of threat of premature labor. However,
postoperatively the patient had an attack of thrombophlebitis in
the right leg and was started on low-molecular-weight heparin
together with empirical antibiotic treatment. General surgeons
performed a Whipple operation 3 months after delivery. Local invasive pancreas adenocarcinoma was diagnosed, and the
patient was referred to medical oncology.

3.

4.

5.

DISCUSSION
Since pancreas carcinoma usually occurs at an older age, it
has rarely been reported during pregnancy. Previous reported
cases (1-8) are summarized in Table 1. The patients generally went to the emergency room due to complaints including abdominal pain, acute abdomen, acute back pain, acute
jaundice, scleral icterus, pancreatitis, and a threat of premature
labor (2-8). Pancreatic cancer was generally diagnosed based on
radiological studies (2, 4-6, 8) or intraoperatively (3, 7) when
emergent laparotomy and/or cesarean section were performed.
At the time of diagnosis of pancreatic cancer in pregnant women, cancer was mainly locally invasive (2, 3, 7, 8) or metastatic
(4-6). Adenocarcinoma, the most common histological subtype
of pancreatic cancer, was associated with the highest mortality
in pregnancy-associated cases (2-6). Other rare subtypes like
mucinous cystic neoplasm or intraductal papillary-mucinous
tumor had better survival rates after treatment (7, 8). Serum
carbohydrate antigen 19-9 has low sensitivity for discriminating benign from malignant pancreatic disease but is generally
high when the mass is large (2, 7-9). Nevertheless, some cases
showed relatively low levels of serum carbohydrate antigen 199, as in our case (5).
Our case involved an obese person, and obesity has been
implicated in pancreatic cancer (10, 11). In addition, higher
levels of circulating C-peptide/insulin and glycemia are risk

290

6.
7.

8.

9.

10.

11.

12.
13.

14.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin
2017;67(1):7-30.
2. Kakoza RM, Vollmer CM Jr, Stuart KE, Takoudes T, Hanto DW. Pancreatic adenocarcinoma in the
pregnant patient: a case report and literature review. J Gastrointest Surg
2009;13(3):535-541.
Blackbourne LH, Jones RS, Catalano CJ, Iezzoni JC, Bourgeois FJ. Pancreatic adenocarcinoma in the pregnant patient: case report and review
of the literature. Cancer 1997;79(9):1776-1179.
Su LL, Biswas A, Wee A, Sufyan W. Placental metastases from pancreatic
adenocarcinoma in pregnancy. Acta Obstet Gynecol Scand 2006;85(5):626-
627.
Marinoni E, Di Netta T, Caramanico L, Tomei B, Moscarini M, Di Iorio
R. Metastatic pancreatic cancer in late pregnancy: a case report and review
of the literature. J Matern Fetal Neonatal Med 2006;19(4):247-249.
Gamberdella FR. Pancreatic carcinoma in pregnancy: a case report. Am
J Obstet Gynecol 1984;149(1):15-17.
Naganuma S, Honda K, Noriki S, Kimura S, Murakami M, Koneri K, Katayama K, Yamaguchi A, Itoh H. Ruptured mucinous cystic neoplasm with
an associated invasive carcinoma of pancreatic head in a pregnant woman:
report of a case and review of literature. Pathol Int 2011;61(1):28-33.
Onuma T, Yoshida Y, Yamamoto T, Kotsuji F. Diagnosis and management
of pancreatic carcinoma during pregnancy. Obstet Gynecol 2010;116(Suppl
2):518-520.
Cao S, Hu Y, Gao X, Liao Q, Zhao Y. Serum carbohydrate antigen 19-9 in
diﬀerential diagnosis of benign and malignant pancreatic cystic neoplasms:
a meta-analysis. PLoS One 2016;11(11):e0166406.
Aune D, Greenwood DC, Chan DS, Vieira R, Vieira AR, Navarro Rosenblatt DA, Cade JE, Burley VJ, Norat T. Body mass index, abdominal
fatness and pancreatic cancer risk: a systematic review and non-linear doseresponse meta-analysis of prospective studies. Ann Oncol 2012;23(4):843-
852.
Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk:
a meta-analysis of prospective studies. Int J Cancer 2007;120(9):1993-
1998.
Pisani P. Hyper-insulinaemia and cancer, meta-analyses of epidemiological
studies. Arch Physiol Biochem 2008;114(1):63-70.
Aggarwal G, Rabe KG, Petersen GM, Chari ST. New-onset diabetes
in pancreatic cancer: a study in the primary care setting. Pancreatology
2012;12(2):156-161.
Chari ST, Leibson CL, Rabe KG, Ransom J, de Andrade M, Petersen GM.
Probability of pancreatic cancer following diabetes: a population-based
study. Gastroenterology 2005;129(2):504-511.

Baylor University Medical Center Proceedings

Volume 30, Number 3

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017

No label
Baylor University Medical Center Proceedings July 2017 - No label
Baylor University Medical Center Proceedings July 2017 - Cover2
Baylor University Medical Center Proceedings July 2017 - 253
Baylor University Medical Center Proceedings July 2017 - 254
Baylor University Medical Center Proceedings July 2017 - 255
Baylor University Medical Center Proceedings July 2017 - 256
Baylor University Medical Center Proceedings July 2017 - 257
Baylor University Medical Center Proceedings July 2017 - 258
Baylor University Medical Center Proceedings July 2017 - 259
Baylor University Medical Center Proceedings July 2017 - 260
Baylor University Medical Center Proceedings July 2017 - 261
Baylor University Medical Center Proceedings July 2017 - 262
Baylor University Medical Center Proceedings July 2017 - 263
Baylor University Medical Center Proceedings July 2017 - 264
Baylor University Medical Center Proceedings July 2017 - 265
Baylor University Medical Center Proceedings July 2017 - 266
Baylor University Medical Center Proceedings July 2017 - 267
Baylor University Medical Center Proceedings July 2017 - 268
Baylor University Medical Center Proceedings July 2017 - 269
Baylor University Medical Center Proceedings July 2017 - 270
Baylor University Medical Center Proceedings July 2017 - 271
Baylor University Medical Center Proceedings July 2017 - 272
Baylor University Medical Center Proceedings July 2017 - 273
Baylor University Medical Center Proceedings July 2017 - 274
Baylor University Medical Center Proceedings July 2017 - 275
Baylor University Medical Center Proceedings July 2017 - 276
Baylor University Medical Center Proceedings July 2017 - 277
Baylor University Medical Center Proceedings July 2017 - 278
Baylor University Medical Center Proceedings July 2017 - 279
Baylor University Medical Center Proceedings July 2017 - 280
Baylor University Medical Center Proceedings July 2017 - 281
Baylor University Medical Center Proceedings July 2017 - 282
Baylor University Medical Center Proceedings July 2017 - 283
Baylor University Medical Center Proceedings July 2017 - 284
Baylor University Medical Center Proceedings July 2017 - 285
Baylor University Medical Center Proceedings July 2017 - 286
Baylor University Medical Center Proceedings July 2017 - 287
Baylor University Medical Center Proceedings July 2017 - 288
Baylor University Medical Center Proceedings July 2017 - 289
Baylor University Medical Center Proceedings July 2017 - 290
Baylor University Medical Center Proceedings July 2017 - 291
Baylor University Medical Center Proceedings July 2017 - 292
Baylor University Medical Center Proceedings July 2017 - 293
Baylor University Medical Center Proceedings July 2017 - 294
Baylor University Medical Center Proceedings July 2017 - 295
Baylor University Medical Center Proceedings July 2017 - 296
Baylor University Medical Center Proceedings July 2017 - 297
Baylor University Medical Center Proceedings July 2017 - 298
Baylor University Medical Center Proceedings July 2017 - 299
Baylor University Medical Center Proceedings July 2017 - 300
Baylor University Medical Center Proceedings July 2017 - 301
Baylor University Medical Center Proceedings July 2017 - 302
Baylor University Medical Center Proceedings July 2017 - 303
Baylor University Medical Center Proceedings July 2017 - 304
Baylor University Medical Center Proceedings July 2017 - 305
Baylor University Medical Center Proceedings July 2017 - 306
Baylor University Medical Center Proceedings July 2017 - 307
Baylor University Medical Center Proceedings July 2017 - 308
Baylor University Medical Center Proceedings July 2017 - 309
Baylor University Medical Center Proceedings July 2017 - 310
Baylor University Medical Center Proceedings July 2017 - 311
Baylor University Medical Center Proceedings July 2017 - 312
Baylor University Medical Center Proceedings July 2017 - 313
Baylor University Medical Center Proceedings July 2017 - 314
Baylor University Medical Center Proceedings July 2017 - 315
Baylor University Medical Center Proceedings July 2017 - 316
Baylor University Medical Center Proceedings July 2017 - 317
Baylor University Medical Center Proceedings July 2017 - 318
Baylor University Medical Center Proceedings July 2017 - 319
Baylor University Medical Center Proceedings July 2017 - 320
Baylor University Medical Center Proceedings July 2017 - 321
Baylor University Medical Center Proceedings July 2017 - 322
Baylor University Medical Center Proceedings July 2017 - 323
Baylor University Medical Center Proceedings July 2017 - 324
Baylor University Medical Center Proceedings July 2017 - 325
Baylor University Medical Center Proceedings July 2017 - 326
Baylor University Medical Center Proceedings July 2017 - 327
Baylor University Medical Center Proceedings July 2017 - 328
Baylor University Medical Center Proceedings July 2017 - 329
Baylor University Medical Center Proceedings July 2017 - 330
Baylor University Medical Center Proceedings July 2017 - 331
Baylor University Medical Center Proceedings July 2017 - 332
Baylor University Medical Center Proceedings July 2017 - 333
Baylor University Medical Center Proceedings July 2017 - 334
Baylor University Medical Center Proceedings July 2017 - 335
Baylor University Medical Center Proceedings July 2017 - 336
Baylor University Medical Center Proceedings July 2017 - 337
Baylor University Medical Center Proceedings July 2017 - 338
Baylor University Medical Center Proceedings July 2017 - 339
Baylor University Medical Center Proceedings July 2017 - 340
Baylor University Medical Center Proceedings July 2017 - 341
Baylor University Medical Center Proceedings July 2017 - 342
Baylor University Medical Center Proceedings July 2017 - 343
Baylor University Medical Center Proceedings July 2017 - 344
Baylor University Medical Center Proceedings July 2017 - 345
Baylor University Medical Center Proceedings July 2017 - 346
Baylor University Medical Center Proceedings July 2017 - 347
Baylor University Medical Center Proceedings July 2017 - 348
Baylor University Medical Center Proceedings July 2017 - 349
Baylor University Medical Center Proceedings July 2017 - 350
Baylor University Medical Center Proceedings July 2017 - 351
Baylor University Medical Center Proceedings July 2017 - 352
Baylor University Medical Center Proceedings July 2017 - 353
Baylor University Medical Center Proceedings July 2017 - 354
Baylor University Medical Center Proceedings July 2017 - 355
Baylor University Medical Center Proceedings July 2017 - 356
Baylor University Medical Center Proceedings July 2017 - 357
Baylor University Medical Center Proceedings July 2017 - 358
Baylor University Medical Center Proceedings July 2017 - 359
Baylor University Medical Center Proceedings July 2017 - 360
Baylor University Medical Center Proceedings July 2017 - 361
Baylor University Medical Center Proceedings July 2017 - 362
Baylor University Medical Center Proceedings July 2017 - 363
Baylor University Medical Center Proceedings July 2017 - 364
Baylor University Medical Center Proceedings July 2017 - 365
Baylor University Medical Center Proceedings July 2017 - 366
Baylor University Medical Center Proceedings July 2017 - 367
Baylor University Medical Center Proceedings July 2017 - 368
Baylor University Medical Center Proceedings July 2017 - 369
Baylor University Medical Center Proceedings July 2017 - 370
Baylor University Medical Center Proceedings July 2017 - 371
Baylor University Medical Center Proceedings July 2017 - 372
Baylor University Medical Center Proceedings July 2017 - 373
Baylor University Medical Center Proceedings July 2017 - 374
Baylor University Medical Center Proceedings July 2017 - 375
Baylor University Medical Center Proceedings July 2017 - 376
Baylor University Medical Center Proceedings July 2017 - 377
Baylor University Medical Center Proceedings July 2017 - 378
Baylor University Medical Center Proceedings July 2017 - 379
Baylor University Medical Center Proceedings July 2017 - 380
Baylor University Medical Center Proceedings July 2017 - 381
Baylor University Medical Center Proceedings July 2017 - 382
Baylor University Medical Center Proceedings July 2017 - 383
Baylor University Medical Center Proceedings July 2017 - 384
Baylor University Medical Center Proceedings July 2017 - 385
Baylor University Medical Center Proceedings July 2017 - 386
Baylor University Medical Center Proceedings July 2017 - 387
Baylor University Medical Center Proceedings July 2017 - 388
Baylor University Medical Center Proceedings July 2017 - 389
Baylor University Medical Center Proceedings July 2017 - 390
Baylor University Medical Center Proceedings July 2017 - 391
Baylor University Medical Center Proceedings July 2017 - 392
Baylor University Medical Center Proceedings July 2017 - Cover3
Baylor University Medical Center Proceedings July 2017 - Cover4
http://www.brightcopy.net/allen/bapr/30-4
http://www.brightcopy.net/allen/bapr/30-3
http://www.brightcopy.net/allen/bapr/30-2
http://www.brightcopy.net/allen/bapr/30-1
http://www.brightcopy.net/allen/bapr/29-4
http://www.brightcopy.net/allen/bapr/29-3
http://www.brightcopy.net/allen/bapr/29-2
http://www.brightcopy.net/allen/bapr/29-1
http://www.brightcopy.net/allen/bapr/28-04
https://www.nxtbook.com/allen/bapr/28-3
https://www.nxtbook.com/allen/bapr/28-2
https://www.nxtbook.com/allen/bapr/28-1
https://www.nxtbook.com/allen/bapr/27-4
https://www.nxtbook.com/allen/bapr/27-3
https://www.nxtbookmedia.com