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Renal cell carcinoma in pregnancy: Report of three cases and review of the literature
Citations from the literature/International Journal of Gynecology & Obstetrics 48 (1995) 245-254 Prelimiuary clinical experience with 8 thermal balloon eodometrial ablstioo metbod to treat menorrbrgia Singer A.; Almanza R.; Gutierrez A.; Haber G.; Bolduc L.R.; Neuwirth R. USA OBSTET GYNECOL 199483/5 I (732-734) Objective: To evaluate the clinical effectivenessand safety of a thermal balloon systemto ablate the endometrium. Methods: All 18 patients were candidates for hysteroscopic endometrial ablation or hysterectomy for menorrhagia and consented to a trial of the balloon technique of ablation. All procedures were done in the operating room under general anesthesia,except in one patient who had regional and another who had local anesthesia with analgesia. Follow-up of 6-34 months is reported. Results: Fifteen subjects (83%) reported significant reduction in bleeding or amenorrhea. Two patients underwent subsequent hysterectomy and one a follow-up hysteroscopic examination with biopsy. Histology in thesethree casesshowed areas of scar as well as areas of normal endometrial histology. In one uterus, the entire cavity and the endometrium were normal. The others had endometrial bands of scar and some contraction of the cavity. Conclusions: Based on follow-up results, the frequency of successfulreduction of bleeding and/or amenorrhea in this small series is comparable to hysteroscopic methodsof endometrial ablation. There were no complications. A larger trial is warranted to compare this method to hysteroscopic endometrial ablation.
DISEASE IN PREGNANCY Reoal cell cerciooma in pregnancy: Report of three cases and review of the literature Smith D.P.; Goldman S.M.; Beggs D.S.; Lanigan P.J. USA OBSTET GYNECOL 1994 83/S II (818-820) Background: Renal cell carcinoma is a potentially fatal tumor that occasionally presents during pregnancy. Based on our experience with three patients and a review of the recent casesin the literature, we believe there has been a change in presentation of this lesion over that described in previous reviews. Cases:Two of three women with renal cell carcinoma found during pregnancy had symptoms suggesting recurrent urinary tract infection. The renal tumors were all discovered by ultrasound. In addition, magnetic resonanceimaging was used for preoperative, intragestational staging of one patient. Conclusion: Renal cell carcinoma should be considered in women of childbearing age who present with recurrent or refractory urinary tract symptoms, flank pain, or a palpable flank mass. Ultrasound appears to be the imaging procedure of choice for evaluating the urinary system in pregnant women. Recurrent pheochromocytomadoring pregnancy SweeneyW.J.; Katz V.L. USA OBSTET GYNECOL 1994 83/5 II (820-822) Background: Pheochromocytoma recurs commonly. The treatment for pheochromocytoma is adrenalectomy, and SUC-
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cessful pregnancy has been achieved after bilateral adrenalectomy. Recurrent pheochromocytoma in pregnancy carries a high risk for mother and fetus. Case: A prim&avid woman with prior bilateral adrenalectomy for pheochromocytoma was followed during her pregnancy with careful attention to the possibility of tumor recurrence.Maternal tachycardia, elevated urinary catecholamines,and rising hematocrit levels indicated recurrence of the pheochromocytoma at 18 weeks’ gestation. Medical therapy and antenatal testing were instituted. Labor was induced at 36 weeks’ gestation because of decreasing amniotic fluid volume, and a healthy 2649-g infant was delivered vaginally. No maternal complications occurred in the postpartum period. Conclusion: One of the signs of recurrent pheochromocytoma is hemoconcentration which, in combination with increasedcatecholamines,may lead to uteroplacental insufficiency. With intense surveillance, good outcomesmay be achieved. Respiratory faihwe in pregnancy doe to poeumocystiscnrinii: Report of a soccesful outcome Albino J.A.; Shapiro J.M. USA OBSTET GYNECOL 199483/S II (823-824) Background: The incidence of infection with the human immunodeficiency virus (HIV) is rising rapidly among women of reproductive age. Pneumocystiscarinii pneumonia during pregnancy may be the first manifestation of HIV infection. If respiratory failure ensues,the outcome has been reported as almost invariably fatal. Case:A 3 1-year-old African-American woman at 28 weeks’ gestation was admitted with bilateral perihilar interstitial infiltrates. Laboratory evaluation revealed hypoxemia and an elevated serumlactic dehydrogenaselevel. Although she denied risk factors for HIV infection, she was treated immediately for P carinii infection with trimethoprimsulfamethoxazole and methylprednisolone. Her respiratory status deteriorated and she required intubation. Bronchoscopy confirmed the diagnosis, and CD4 lymphocyte depletion confirmed immunosuppression. The patient responded to treatment and recovered completely. Conclusion: A high index of suspicion must be maintained for the diagnosis of P carinii and previously unsuspectedHIV infection during pregnancy. The early manifestations may be subtle and progress over weeks until respiratory failure rapidly ensues.With timely diagnosis and management,the outcome of P carinii pneumonia in pregnancy can be successful.
Pregnmcy complicated by thrombocytopeoia secondary to human immormdeficiencyvirus infection Glantz J.C.; Roberts D.J. USA OBSTET GYNECOL 199483/5 II (825-827) Background: Human immunodeficiency virus (HIV)-positive pregnant women may manifest thrombocytopenia similar to that of immune thrombocytopenic purpura (ITP), putting the fetus at risk of thrombocytopenia and hemorrhage. Whereas
DISEASE IN PREGNANCY Reoal cell cerciooma in pregnancy: Report of three cases and review of the literature Smith D.P.; Goldman S.M.; Beggs D.S.; Lanigan P.J. USA OBSTET GYNECOL 1994 83/S II (818-820) Background: Renal cell carcinoma is a potentially fatal tumor that occasionally presents during pregnancy. Based on our experience with three patients and a review of the recent casesin the literature, we believe there has been a change in presentation of this lesion over that described in previous reviews. Cases:Two of three women with renal cell carcinoma found during pregnancy had symptoms suggesting recurrent urinary tract infection. The renal tumors were all discovered by ultrasound. In addition, magnetic resonanceimaging was used for preoperative, intragestational staging of one patient. Conclusion: Renal cell carcinoma should be considered in women of childbearing age who present with recurrent or refractory urinary tract symptoms, flank pain, or a palpable flank mass. Ultrasound appears to be the imaging procedure of choice for evaluating the urinary system in pregnant women. Recurrent pheochromocytomadoring pregnancy SweeneyW.J.; Katz V.L. USA OBSTET GYNECOL 1994 83/5 II (820-822) Background: Pheochromocytoma recurs commonly. The treatment for pheochromocytoma is adrenalectomy, and SUC-
247
cessful pregnancy has been achieved after bilateral adrenalectomy. Recurrent pheochromocytoma in pregnancy carries a high risk for mother and fetus. Case: A prim&avid woman with prior bilateral adrenalectomy for pheochromocytoma was followed during her pregnancy with careful attention to the possibility of tumor recurrence.Maternal tachycardia, elevated urinary catecholamines,and rising hematocrit levels indicated recurrence of the pheochromocytoma at 18 weeks’ gestation. Medical therapy and antenatal testing were instituted. Labor was induced at 36 weeks’ gestation because of decreasing amniotic fluid volume, and a healthy 2649-g infant was delivered vaginally. No maternal complications occurred in the postpartum period. Conclusion: One of the signs of recurrent pheochromocytoma is hemoconcentration which, in combination with increasedcatecholamines,may lead to uteroplacental insufficiency. With intense surveillance, good outcomesmay be achieved. Respiratory faihwe in pregnancy doe to poeumocystiscnrinii: Report of a soccesful outcome Albino J.A.; Shapiro J.M. USA OBSTET GYNECOL 199483/S II (823-824) Background: The incidence of infection with the human immunodeficiency virus (HIV) is rising rapidly among women of reproductive age. Pneumocystiscarinii pneumonia during pregnancy may be the first manifestation of HIV infection. If respiratory failure ensues,the outcome has been reported as almost invariably fatal. Case:A 3 1-year-old African-American woman at 28 weeks’ gestation was admitted with bilateral perihilar interstitial infiltrates. Laboratory evaluation revealed hypoxemia and an elevated serumlactic dehydrogenaselevel. Although she denied risk factors for HIV infection, she was treated immediately for P carinii infection with trimethoprimsulfamethoxazole and methylprednisolone. Her respiratory status deteriorated and she required intubation. Bronchoscopy confirmed the diagnosis, and CD4 lymphocyte depletion confirmed immunosuppression. The patient responded to treatment and recovered completely. Conclusion: A high index of suspicion must be maintained for the diagnosis of P carinii and previously unsuspectedHIV infection during pregnancy. The early manifestations may be subtle and progress over weeks until respiratory failure rapidly ensues.With timely diagnosis and management,the outcome of P carinii pneumonia in pregnancy can be successful.
Pregnmcy complicated by thrombocytopeoia secondary to human immormdeficiencyvirus infection Glantz J.C.; Roberts D.J. USA OBSTET GYNECOL 199483/5 II (825-827) Background: Human immunodeficiency virus (HIV)-positive pregnant women may manifest thrombocytopenia similar to that of immune thrombocytopenic purpura (ITP), putting the fetus at risk of thrombocytopenia and hemorrhage. Whereas