Correspondence

Transplacental Transfer of Small-Cell Carcinoma of the Lung

N Engl J Med 2002; 346:1501-1502May 9, 2002

Article

To the Editor:

Although the estimated rate of cancer during pregnancy is 1 case per 1000 live births,1 and placental metastases are not uncommon, transplacental transmission of maternal tumors is rare. We report a case of small-cell carcinoma of the lung transmitted from a 37-year-old mother to her infant. At the time of delivery, the mother presented with a history of six weeks of increasing dyspnea, a nonproductive cough, and weight loss. She had a 40-pack-year history of cigarette smoking. Radiographs showed a central lesion in the left lung, a mass in the chest wall, and liver nodules. Biopsies of the chest wall and bone marrow showed metastatic small-cell carcinoma; the findings were consistent with a pulmonary origin. Despite aggressive therapy, she died five months later.

A preterm, 33-week-old boy was delivered by cesarean section. The placenta was infiltrated with small-cell carcinoma (Figure 1Figure 1Photomicrographs of the Placenta.). Laboratory and radiographic studies were unremarkable at birth, at three weeks, and at three months. At five months, computed tomographic scans showed nodules in the liver and right lung. A liver biopsy showed metastatic small-cell carcinoma similar to that seen in the placenta. Analysis of the liver-biopsy specimen with the use of fluorescence in situ hybridization showed a subpopulation of cells with a female XX pattern, a finding consistent with a tumor of maternal origin.

The infant was treated with cisplatin, etoposide, cyclophosphamide, and topotecan, followed by consolidation therapy with carboplatin, etoposide, and melphalan and by autologous bone marrow transplantation. The boy is now one year old; he is well and has no evidence of recurrent disease.

Transplacental transmission of malignant cells is rare. In such cases, metastatic disease has appeared at birth to 20 months of age and at least 65 percent of patients have died from metastatic tumors.2

Jakub Tolar, M.D., Ph.D.
James E. Coad, M.D.
Joseph P. Neglia, M.D., M.P.H.
University of Minnesota School of Medicine, Minneapolis, MN 55455
tolar@lenti.med.umn.edu

2 References

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   Dildy GA III, Molse KJ Jr, Carpenter RJ Jr, Klima T. Maternal malignancy metastatic to the products of conception: a review. Obstet Gynecol Surv 1989;44:535-540
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Citing Articles (7)

Citing Articles

1. 1

   Hatem A. Azim, Fedro A. Peccatori, Nicholas Pavlidis. (2010) Lung cancer in the pregnant woman: To treat or not to treat, that is the question. Lung Cancer 67:3, 251-256
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2. 2

   Marylou C. Thelmo, Ellen P. Shen, Savita Shertukde. (2010) METASTATIC PULMONARY ADENOCARCINOMA TO PLACENTA AND PLEURAL FLUID: Clinicopathologic Findings. Fetal & Pediatric Pathology 29:1, 45-56
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3. 3

   (2008) Case 4-2008: A Pregnant Woman with a Swollen Left Breast and Dyspnea. New England Journal of Medicine 358:26, 2848-2849
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4. 4

   C BURLACU, C FITZPATRICK, M CAREY. (2007) Anaesthesia for caesarean section in a woman with lung cancer: case report and review. International Journal of Obstetric Anesthesia 16:1, 50-62
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5. 5

   Alison Louise Jones. (2006) Management of pregnancy-associated breast cancer. The Breast 15, S47-S52
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6. 6

   Mignon L. Loh, Katherine K. Matthay. 2005. Congenital Malignant Disorders. , 1437-1470.
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7. 7

   Jakub Tolar, Joseph P. Neglia. (2003) Transplacental and Other Routes of Cancer Transmission Between Individuals. Journal of Pediatric Hematology/Oncology 25:6, 430-434
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