Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy

• Published in: The journal of obstetrics and gynaecology research 2014-04, Vol.40 (4), p.1150-1153
• Main Authors: Jeong, Bada, Shim, Jae‐Yoon, Kim, Chong Jai, Won, Hye‐Sung, Lee, Pil Ryang, Kim, Ahm
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - blood supply; Adenocarcinoma - metabolism; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adult; Chorionic Villi - blood supply; Chorionic Villi - metabolism; Chorionic Villi - pathology; Female; Fibrin - metabolism; gastric cancer; Humans; metastasis; Necrosis; Neoplasm Proteins - metabolism; perivillous fibrin deposition; Placenta - blood supply; Placenta - metabolism; Placenta - pathology; Placental Circulation; Pregnancy; Stomach Neoplasms - metabolism; Stomach Neoplasms - pathology; Trophoblastic Tumor, Placental Site - blood supply; Trophoblastic Tumor, Placental Site - metabolism; Trophoblastic Tumor, Placental Site - pathology; Trophoblastic Tumor, Placental Site - secondary; Up-Regulation; Uterine Neoplasms - blood supply; Uterine Neoplasms - metabolism; Uterine Neoplasms - pathology; Uterine Neoplasms - secondary; Uterus - blood supply; Uterus - metabolism; Uterus - pathology
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.12292

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.