Rapid Progression of Lung Cancer Following Emergency Caesarean Section Led to Postpartum Acute Respiratory Failure

Abstract

Our case patient was a 38-year-old pregnant Japanese woman who underwent emergency Caesarean section because of massive vaginal bleeding due to a low-lying placenta. Immediately after delivery, she presented with rapidly progressive dyspnea. Contrast-enhanced computed tomography revealed bilateral pleural effusion, lung nodules, multiple liver tumors, and multiple osteolytic lesions. Accordingly, epidermal growth factor receptor-mutant advanced lung adenocarcinoma was diagnosed. This report highlights the occurrence of rapid progression of lung cancer following delivery that led to postpartum acute respiratory failure, rather than due to pulmonary thromboembolism associated with the existing deep venous thrombosis of the inferior vena cava.

Keywords: epidermal growth factor receptor mutation; gefitinib; lung cancer combined with pregnancy; postpartum acute respiratory failure.

Figure 1.

The clinical course showing the chest X-ray findings, treatment regimens, and the requirement and modalities of oxygen therapy. ICU: intensive-care unit, NHF: nasal high-flow oxygen, NPPV: non-invasive positive-pressure ventilation

Figure 2.

Chest X-ray findings on hospital day 6 after delivery by Caesarean section showing pulmonary congestion and reduced permeability, primarily in the lower lung fields.

Figure 3.

Contrast-enhanced whole-body computed tomography images showing bilateral pleural effusion, multiple lung small nodules (A), multiple liver tumors (B), and osteolytic changes in the iliac bones (C: black solid arrows). No signs of pulmonary embolism can be seen; however, thrombi can be seen in the splenic vein, abdominal inferior vena cava (C: black dotted arrow), and the left common iliac vein.

Figure 4.

Sputum cytology of Papanicolaou stain (A; original magnification, 20×) indicating adenocarcinoma cells with nuclear ubiquity, nuclear enlargement, and nuclear irregularity. Cytology of pleural effusion of Papanicolaou stain (B; original magnification, 20×) showing adenocarcinoma with an abnormal cell cluster, indicating nuclear enlargement and anisokaryosis.

Figure 5.

Cell block cytology of the pleural effusion. Hematoxylin and Eosin staining (A; original magnification, 20×) demonstrated adenocarcinoma with abnormal cells showing nuclear enlargement and anisokaryosis; immunostaining for thyroid transcription factor-1 (TTF-1, B; original magnification, 20×) showed positive expression in the nuclei of abnormal cells.