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Anesthetic management of cervical small cell neuroendocrine tumor diagnosed in the peripartum period.
Abstract Number: T4C-7
Abstract Type: Case Report/Case Series
Introduction: Neuroendocrine tumors are rarely encountered in pregnancy. We present a case of cervical small cell neuroendocrine tumor diagnosed during the 26th week of gestation.
Case Presentation: A 34 yo G2P1 female with history significant for hypertension and PCOS presented for recurrent vaginal bleeding at 26 weeks EGA. Speculum exam revealed non-fetal tissue attached to a stalk protruding through the cervix; pathology confirmed small-cell neuroendocrine tumor. Further imaging did not reveal any signs of metastasis. Decision was made to proceed with a pre-term delivery via classical cesarean section followed immediately by total abdominal hysterectomy, given the patient’s need for urgent chemotherapy secondary to the expected aggressiveness of tumor burden, as well as the paucity of data regarding the treatment of neuroendocrine tumors diagnosed during pregnancy. After receiving an outpatient course of betamethasone, the patient presented to the hospital at 32w5d GA for delivery. Decision was made to perform a combined spinal-epidural (CSE) to provide anesthesia for delivery, followed by transition to a general endotracheal anesthetic for immediate radical hysterectomy. Patient was extubated at the end of the case, transferred to the mother-baby unit, completed an uneventful post-operative course and was discharged home with a healthy neonate on POD #3. Examination of the tumor and uterus by pathology would later confirm a small-cell neuroendocrine tumor of the cervix. After a brief period of recovery, the patient began a course of chemotherapy and has subsequently undergone four additional cycles to this point in time.
Discussion: Neuroendocine tumors of the gynecologic tract are relatively rare and often quite aggressive[1, 2]. Because of this infrequency, the prognostic factors and optimal treatment modalities are often without consensus . The International Federation of Gynaecology and Obstetrics (FIGO) staging criteria are often considered to be an important indicator of prognosis. The median failure-free survival rate has been quoted at 16 months, with a median cancer-free survival rate of 24 months . Staging and lymph node involvement play a major role in expected survival, as does treatment with chemotherapy .
1. Viswanathan 2004
2. Wang 2012
3. Lee 2010