Management Strategies for Brain Tumors Diagnosed during Pregnancy: A Case Report and Literature Review

Abstract

Background and Objectives: Maternal brain tumors diagnosed during pregnancy are very rare, and their clinical course remains incompletely understood. We recently experienced a case of a brain tumor diagnosed at 30 weeks of gestation, and the treatment was initiated after delivery at 32 weeks of gestation. In this study, we reviewed case reports of brain tumors diagnosed during pregnancy, focusing on whether the brain tumor was treated during pregnancy or after termination of pregnancy and on the timing of therapeutic intervention. Materials and Methods: We searched PubMed and Ichushi-Web for articles published after January 2000 that reported cases of maternal brain tumors diagnosed during pregnancy. The patients were divided into two groups according to whether the tumor was treated during pregnancy (Group A) or after termination of pregnancy (Group B). Results: In total, 42 patients were included in the study (13 (31%) in Group A and 29 (69%) in Group B). The most common symptoms before diagnosis were those caused by increased intracranial pressure (57.1%). The diagnosis was made at 18 ± 6 weeks of gestation in Group A and 26 ± 9 weeks of gestation in Group B (p = 0.007). In all cases diagnosed after 34 weeks of gestation, termination of pregnancy was followed by treatment. Treatment was initiated within two weeks of diagnosis in 50% of patients in Group A and 30% in Group B. Conclusions: When severe symptoms caused by increased intracranial pressure last for several weeks, imaging tests should be considered. Termination of pregnancy is a good option for a brain tumor diagnosed after 34 weeks of gestation, while comprehensive treatment decisions should be made based on the severity of symptoms and the course of pregnancy in other cases.

Keywords: brain tumor; choroid plexus papilloma; pregnancy; termination.

Figure 1

Magnetic resonance imaging of the brain and a specimen of the tumor. Imaging confirmed a mass (yellow arrow) on the left cerebellopontine angle compressing the brainstem (red arrow) and nearly obstructing the fourth ventricle (blue arrow). (A) T2-weighted image, horizontal section. (B) T2-weighted image, sagittal section. (C) T2-weighted image 14 days after the tumor resection, horizontal section. (D) A photomicrograph of a surgical specimen showing a papillary structure covered with a single layer of columnar epithelial cells along a narrow interstitium with abundant vessels. Hematoxylin and eosin stain, ×100, with a scale bar of 50 μm.

Figure 2

Literature search of PubMed and Ichushi-Web (Japan Medical Abstracts Society). (A) Literature search by PubMed. (B) Literature search by Ichushi-Web. The date of the last search was 30 July 2020. The search in Japanese was conducted by substituting English terms with Japanese synonyms.

Figure 3

Gestational weeks at diagnosis of brain tumors and the time between diagnosis and initiation of treatment. (A) Number of cases in which treatment of the tumor was conducted during pregnancy (Group A) or after termination of pregnancy (Group B). Cases were divided into three groups according to the timing of diagnosis: before 21 weeks, 22 to 33 weeks and after 34 weeks of gestation. The numbers of cases in which patients were treated during pregnancy (Group A) and treated postpartum (Group B) are indicated by blue and orange, respectively. (B) Time between diagnosis and initiation of treatment of the tumor in Group A and Group B. The time between diagnosis and treatment in each group is illustrated in a pie graph. Three cases were excluded because data were unavailable. (C) Time between diagnosis and termination of pregnancy according to the timing of diagnosis in Group B. The time between diagnosis and termination of pregnancy was divided into three groups according to the timing of diagnosis: before 21 weeks, 22 to 33 weeks and after 34 weeks of gestation. The number of cases is shown in a pie graph. One case was excluded because data were unavailable.