Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice)
The article presents the case of 32 years old woman with non-Hodgkin’s lymphoma of the nasopharynx who received the anticancer treatment at 21-26 weeks of pregnancy (20 courses of radiation in dose of 40 Gy on the right half of the nasopharynx). The pregnancy was performed by cesarean section at the...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
2011
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| Цитувати: | Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) / N. Kitsera, N. Helner, O. Kitsera, Z. Osadchuk // Experimental Oncology. — 2011. — Т. 33, № 2. — С. 110-111. — Бібліогр.: 8 назв. — англ. |
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nasplib_isofts_kiev_ua-123456789-1386182025-02-23T17:38:31Z Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) Kitsera, N. Helner, N. Kitsera, O. Osadchuk, Z. Short communications The article presents the case of 32 years old woman with non-Hodgkin’s lymphoma of the nasopharynx who received the anticancer treatment at 21-26 weeks of pregnancy (20 courses of radiation in dose of 40 Gy on the right half of the nasopharynx). The pregnancy was performed by cesarean section at the term of 32 weeks, and a healthy girl was born. Timely diagnosis and correct treatment of non-Hodgkin’s lymphoma give the woman a chance to have a healthy child. 2011 Article Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) / N. Kitsera, N. Helner, O. Kitsera, Z. Osadchuk // Experimental Oncology. — 2011. — Т. 33, № 2. — С. 110-111. — Бібліогр.: 8 назв. — англ. 1812-9269 https://nasplib.isofts.kiev.ua/handle/123456789/138618 en Experimental Oncology application/pdf Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Digital Library of Periodicals of National Academy of Sciences of Ukraine |
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Short communications Short communications |
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Short communications Short communications Kitsera, N. Helner, N. Kitsera, O. Osadchuk, Z. Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) Experimental Oncology |
| description |
The article presents the case of 32 years old woman with non-Hodgkin’s lymphoma of the nasopharynx who received the anticancer treatment at 21-26 weeks of pregnancy (20 courses of radiation in dose of 40 Gy on the right half of the nasopharynx). The pregnancy was performed by cesarean section at the term of 32 weeks, and a healthy girl was born. Timely diagnosis and correct treatment of non-Hodgkin’s lymphoma give the woman a chance to have a healthy child. |
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Article |
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Kitsera, N. Helner, N. Kitsera, O. Osadchuk, Z. |
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Kitsera, N. Helner, N. Kitsera, O. Osadchuk, Z. |
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Kitsera, N. |
| title |
Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
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Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
| title_full |
Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
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Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
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Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
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non-hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) |
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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2011 |
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Short communications |
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https://nasplib.isofts.kiev.ua/handle/123456789/138618 |
| citation_txt |
Non-Hodgkin’s lymphoma of nasopharynx diagnosed during pregnancy (a case from practice) / N. Kitsera, N. Helner, O. Kitsera, Z. Osadchuk // Experimental Oncology. — 2011. — Т. 33, № 2. — С. 110-111. — Бібліогр.: 8 назв. — англ. |
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Experimental Oncology |
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110 Experimental Oncology 33, 110–111, 2011 (June)
NON-HODGKIN’S LYMPHOMA OF NASOPHARYNX DIAGNOSED
DURING PREGNANCY (A CASE FROM PRACTICE)
N. Kitsera1, N. Helner1, O. Kitsera2, Z. Osadchuk1
1Institute of Hereditary Pathology of National Academy of Medical Sciences of Ukraine, Lviv, Ukraine
2 Danylo Halytsky National Medical University, Lviv, Ukraine
The article presents the case of 32 years old woman with non-Hodgkin’s lymphoma of the nasopharynx who received the antican-
cer treatment at 21-26 weeks of pregnancy (20 courses of radiation in dose of 40 Gy on the right half of the nasopharynx). The
pregnancy was performed by cesarean section at the term of 32 weeks, and a healthy girl was born. Timely diagnosis and correct
treatment of non-Hodgkin’s lymphoma give the woman a chance to have a healthy child.
Key Words: pregnancy, non-Hodgkin’s lymphoma, fetus, newborn
Cancer is the second leading cause of death
in women of reproductive age. The most common
tumors diagnosed during pregnancy are breast and
cervical cancer, Hodgkin’s lymphoma and non-Hodg-
kin’s lymphoma, leukemias, and malignant melanoma.
The aim of therapy in pregnancy is to give optimal treat-
ment to a mother without harm to a fetus. In the first
trimester organogenesis continues, so chemotherapy
should not be given because of increasing risk of spon-
taneous abortion, fetal malformation, and mortality.
One of important and actual problems of modern
oncology and hematology is diagnostics and treat-
ment of non-Hodgkin’s lymphoma [1, 2]. Frequency
of non-Hodgkin’s lymphoma is constantly increasing
both in Ukraine and in the world. From the data of Na-
tional Cancer-Register Bulletin of Ukraine an amount
of the first registered cases of non-Hodgkin’s lym-
phomas in 2008 year was 2088. An index of morbid-
ity on 100 thousands of population is 4.4, among
women — 3.6, among men — 5.4. Lethality of primary
patients with non-Hodgkin’s lymphomas in Ukraine
is 36.5% during one year. In 30–35 % of patients the
primary standard treatment results in the progress-
ing or relapse of the disease. The index of five-year
survival in the group of patients does not exceed
30–40%. Thus, the problem of diagnostics and
treatment of non-Hodgkin’s lymphomas is of high
actuality [3].
Also, practical gynecologists have the certain warn-
ings concerning the conduct of pregnancy and births
in women with oncopathology in anamnesis, especially
if this pathology is diagnosed during pregnancy [4–6].
Most of women with such diagnosis do not risk to plan
a pregnancy, because they are afraid to give a sick
child and don’t know where to receive a qualified help.
In this case report, we have retrospectively
analyzed a case of a patient with non-Hodgkin’s lym-
phoma of nasopharynx that was diagnosed during
pregnancy and who received anticancer treatment
during pregnancy.
The patient O.P., 32 years of old, was under a su-
pervision in woman’s consultation at the home clinic
concerning the first pregnancy. She was complaining
a bed nasal breathing, obstruction of the nose, short
breathing, headache, which was not controlled under
the standard methods of treatment. After consultation
the non-Hodgkin’s lymphoma of nasopharynx was
diagnosed.
The patient appealed to the medical genetic center
of Institute of Hereditary Pathology (Lviv, Ukraine) for
determination of possible risk for birth defects and ab-
normalities of her child, as far as the malignant tumor
was diagnosed during pregnancy and she disagreed
on terminating pregnancy.
During the genealogical examination it has been
found that her paternal uncle died from the cancer
of digestive system at the age of 50. Husband’s aunt
died at age of 70 from cancer of inner organs. Birth
defects, abnormalities, childless marriages, abortions,
stillbirth were not discovered in this family tree. The
woman wanted to save pregnancy and to have a child,
so she was looking for support and help in different
state and private clinics.
At the comprehensive assessment of pregnant
woman somatic pathology was not found, only in-
creased post-neck lymphatic nodules from both sides
(0.2–0.4 cm).
Computer tomography from 29.12.2009 has
revealed the picture of volume process of right half
of nasal cavity with distribution to the right wall of naso-
pharynx. It needed differentiation between tumor and
polyposis. While at the beginning of observation blast
cells were not found, but complaint increased and the
clinical state got worse; so other researches were done.
Immunological research, conducted on 14.01.2010,
did not find signs of clonal proliferation of cells. Mor-
phological research from 20.01.2010 of bone marrow
discovered 21–23% lymphocytes, blast cells were
not found. Pathoanatomical conclusion of trepana-
tion of iliac bone from 27.01.2010 revealed the focal
affection of marrow diagnosed as at a large cell lym-
phoma. The analysis of blood from 25.01.2010, done
in a term of 16–17 weeks of pregnancy, demonstrated
Received: March 29, 2011.
*Correspondence: Fax: (032) 223 07 67
E-mail: nkitsera@gmail.com
Exp Oncol 2011
33, 2, 110–111
Experimental Oncology 33, 110–111, 2011 (June) 111
only the high indexes of ESR — 42 mm per hour, and
insignificant decrease of hemoglobin — 105 g/L. Other
blood indexes and coagulogram were normal. During
ultrasound examination from 03.02.2010 what corre-
sponded to 18 weeks of pregnancy, no pathologies and
abnormalities of fetus organs and placenta were found.
Only an uterus was in hypertonus. During the dynamic
ultrasound examinations no pathology of fetus, and
fetometric data according to the term of gestation were
found. The repeated computer tomography of brain
from 25.02.2010 found the signs of tumor of right half
of nasal cavity with dissemination in ethmoidal, sphe-
noid and maxillary sinuses at the same side.
Conclusion of internal pathology specialists:
17 weeks pregnancy, a non-Hodgkin’s lymphoma
of right half of nasal cavity. A patient was informed
about the risk of birth defects, malformations, lack
of amniotic fluid and possible antenatal death of fetus.
Taking into account woman’s categorical refusal
of medical abortion, the tactic of treatment was lim-
ited to the tele-gamma-therapy at the maintenance
of pregnancy. On the patient’s consent the treatment
was conducted from 01.03.2010 to 10.04.2010 during
21–26 weeks of pregnancy (20 courses of irradiation
in a dose 40 Grey on the right half of nasal cavity). The
patient listened to the advices of doctors, which took
into account all risks (mutagenic, teratogenic, and
also carcinogenic effects on a fetus), and the chances
of successful completion of pregnancy, that support
her faith and her hope to born a healthy child. After
termination of tele-gamma-therapy, relapse of tumor
was not found.
The conclusion of oncologists from 20.04.2010 was:
a non-Hodgkin’s lymphoma of nasal cavity grade ІІ,
state after a tele-gamma-therapy, 28 weeks of preg-
nancy. They recommended the woman to prolong the
treatment after delivery.
As the clinical manifestation of non-Hodgkin’s lym-
phoma of nasal cavity was revealed in the ІІ trimester
of pregnancy, a risk of the teratogenic effect is low
(1–2%). The conducted tele-gamma-therapy during
pregnancy (21–26 week) promotes the risk of new
mutations, particularly in the somatic cells of fetus
to 1–2%, and also an appearance of dysmorphic minor
birth anomalies. The pregnant woman was informed
about possible carcinogenic effect on fetus (1–2%),
and also the risk of low birth weight, decreased im-
munity of child and perinatal losses with recognition
of general population risk — 5%. The total risk of birth
defects and hereditary pathology in this situation was
8–11%. The decision of woman was to prolong preg-
nancy and to give birth to a child.
At the term of 32 weeks of pregnancy (18.05.2010)
by Caesar section the healthy girl was born with the
weight of 2040 g, height of 45 cm, by 7 points of Apgar.
The newborn was diagnosed with anaemia of I-st de-
gree (109 g/L).
Regardless on heavy oncological pathology,
the patient felt normal after delivery. The woman
began the course of chemotherapy (mabtera, cy-
clophosphamide, doxorubicin, vincristine) in July,
2010 —1.5 months after delivery, and continues the
treatment. Undesirable effect of treatment was alo-
pecia, diarrhea, enhanceable nervousness.
01.10.2010 at the age of 4.5 months, the
child’s weighs was 6 kg, haemoglobin was 150 g/L. Af-
ter the chil’s examination, a conclusion of pediatrician,
neurologist, haematologist and other specialists was
“clinically healthy, physical growth corresponds to the
age”.
This case from practice, about the non-Hodg-
kin’s lymphoma of nasal cavity in pregnant woman and
its correct treatment during pregnancy, has showed
how to overcome acute flow of illness, to born a healthy
child, and continue treatment after delivery, when
a patient is positively adjusted by doctor’s and family
support [7–8]. The close collaboration of gynecolo-
gists, oncologists, geneticists and doctors of other
specialities, the selection of correct treatment modality
of cancer during pregnancy reduce the risks of compli-
cations and delivery and give woman a chance to born
a healthy child.
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