Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: case report and literature review

      Pancreatic cancer is rarely diagnosed during pregnancy; it usually manifests with symptoms such as epigastric pain, vomiting, weight loss, and jaundice, rarely mimicking the hemolysis, elevated liver enzymes, and low platelet count syndrome. It has been postulated that there exists a correlation between the diagnosis of gestational diabetes mellitus and the occurrence of pancreatic cancer later in life. We conducted an expert literature review of the 31 available documented pancreatic cancer cases that were diagnosed during pregnancy. We also report pancreatic adenocarcinoma incidentally suspected in an asymptomatic woman affected by gestational diabetes mellitus; the woman was undergoing a fetal growth scan.

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      References

        • Duffy A
        • Capanu M
        • Allen P
        • et al.
        Pancreatic adenocarcinoma in a young patient population—12-year experience at Memorial Sloan Kettering Cancer Center.
        J Surg Oncol. 2009; 100: 8-12
        • Hidalgo M
        Pancreatic cancer.
        N Engl J Med. 2010; 362: 1605-1617
        • Klein AP
        Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors.
        Nat Rev Gastroenterol Hepatol. 2021; 18: 493-502
        • American Diabetes Association
        2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020.
        Diabetes Care. 2020; 43: S14-S31
        • International Diabetes Federation
        IDF diabetes atlas.
        9th edition. 2019 (Available at:) (Accessed September 1, 2021)
        • Quaresima P
        • Visconti F
        • Chiefari E
        • et al.
        Appropriate timing of gestational diabetes mellitus diagnosis in medium- and low-risk women: effectiveness of the Italian NHS recommendations in preventing fetal macrosomia.
        J Diabetes Res. 2020; 20205393952
        • Di Cianni G
        • Gualdani E
        • Berni C
        • et al.
        Screening for gestational diabetes in Tuscany, Italy. A population study.
        Diabetes Res Clin Pract. 2017; 132: 149-156
        • Perrin MC
        • Terry MB
        • Kleinhaus K
        • et al.
        Gestational diabetes as a risk factor for pancreatic cancer: a prospective cohort study.
        BMC Med. 2007; 5: 25
        • Boyle JM
        • McLeod ME
        Pancreatic cancer presenting as pancreatitis of pregnancy. Case report.
        Am J Gastroenterol. 1978; 70: 371-373
        • Gamberdella FR
        Pancreatic carcinoma in pregnancy: a case report.
        Am J Obstet Gynecol. 1984; 149: 15-17
        • Baiocchi C
        • Landonio G
        • Majno M
        • Minola E
        • Scanzi F
        • Ghislandi E
        Pancreatic cystadenocarcinoma and pregnancy: a case report.
        Tumori. 1990; 76: 294-295
        • Porcel JM
        • Ordi J
        • Castells L
        • Farran I
        Probable pancreatic cancer in a pre-eclamptic patient.
        Eur J Obstet Gynecol Reprod Biol. 1992; 44: 80-82
        • Simchuk EJ
        • Welch JP
        • Orlando R
        Antepartum diagnosis of pancreatic carcinoma: a case report.
        Conn Med. 1995; 59: 259-262
        • Blackbourne LH
        • Jones RS
        • Catalano CJ
        • Iezzoni JC
        • Bourgeois FJ
        Pancreatic adenocarcinoma in the pregnant patient: case report and review of theliterature.
        Cancer. 1997; 79: 1776-1779
        • Gojnic M
        • Boskovic V
        • Fazlagic A
        • et al.
        Pancreatic tumor in a pregnant woman: a rare case report.
        Eur J Gynaecol Oncol. 2005; 26: 221-224
        • Marinoni E
        • Di Netta T
        • Caramanico L
        • Tomei B
        • Moscarini M
        • Di Iorio R
        Metastatic pancreatic cancer in late pregnancy: a case report and review of the literature.
        J Matern Fetal Neonatal Med. 2006; 19: 247-249
        • Su LL
        • Biswas A
        • Wee A
        • Sufyan W
        Placental metastases from pancreatic adenocarcinoma in pregnancy.
        Acta Obstet Gynecol Scand. 2006; 85: 626-627
        • Ozden S
        • Haliloglu B
        • Ilter E
        • Akin FT
        • Kebudi A
        • Peker O
        An extremely rare cause of acute abdomen in pregnancy: ruptured pancreatic mucinous cystadenocarcinoma.
        Pancreas. 2007; 34: 474-476
        • Herring AA
        • Graubard MB
        • Gan SI
        • Schwaitzberg SD
        Mucinous cystadenocarcinoma of the pancreas during pregnancy.
        Pancreas. 2007; 34: 470-473
        • Al-Adnani M
        • Kiho L
        • Scheimberg I
        Maternal pancreatic carcinoma metastatic to the placenta: a case report and literature review.
        Pediatr Dev Pathol. 2007; 10: 61-65
        • Somoye G
        • Praseedom RK
        • Hoveyda F
        Adenocarcinoma of the pancreas complicated by obstructive jaundice in pregnancy.
        J Obstet Gynaecol. 2008; 28: 536-537
        • Kakoza RM
        • Vollmer Jr, CM
        • Stuart KE
        • Takoudes T
        • Hanto DW
        Pancreatic adenocarcinoma in the pregnant patient: a case report and literature review.
        J Gastrointest Surg. 2009; 13: 535-541
        • Onuma T
        • Yoshida Y
        • Yamamoto T
        • Kotsuji F
        Diagnosis and management of pancreatic carcinoma during pregnancy.
        Obstet Gynecol. 2010; 116: 518-520
        • Perera D
        • Kandavar R
        • Palacios E
        Pancreatic adenocarcinoma presenting as acute pancreatitis during pregnancy: clinical and radiologic manifestations.
        J La State Med Soc. 2011; 163: 114-117
        • Marci R
        • Pansini G
        • Zavatta C
        • et al.
        Pancreatic cancer with liver metastases in a pregnant patient: case report and review of the literature.
        Clin Exp Obstet Gynecol. 2012; 39: 127-130
        • Lubner S
        • Hall B
        • Gopal D
        • et al.
        A 37 year-old pregnant woman with pancreatic adeno-carcinoma treated with surgery and adjuvant chemotherapy: a case report and literature review.
        J Gastrointest Oncol. 2011; 2: 258-261
        • Liu SV
        • Von Hoff DD
        • Schroeder KB
        • Jameson GS
        • Dubovsky DW
        Metastatic pancreatic cancer during pregnancy presenting as pseudo-Meigs’ syndrome.
        Gynecol Surg. 2012; 9: 323-325
        • Boyd CA
        • Benarroch-Gampel J
        • Kilic G
        • Kruse EJ
        • Weber SM
        • Riall TS
        Pancreatic neoplasms in pregnancy: diagnosis, complications, and management.
        J Gastrointest Surg. 2012; 16: 1064-1071
        • Papoutsis D
        • Sindos M
        • Papantoniou N
        • Antsaklis A
        Management options and prognosis of pancreatic adenocarcinoma at 16 weeks’ gestation: a case report.
        J Reprod Med. 2012; 57: 167-170
      1. Hernández FU, Álvarez CZ, Hernández NF, et al. Cáncer pancreático y embarazo. 2014. Available at:http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1405-00992014000300168&lng=es&nrm=iso. Accessed July 1, 2014.

        • Lui MW
        • Lai CWS
        • Ong CY-T
        Metastatic pancreatic adenocarcinoma presented as back pain in pregnancy: case report and review of literature.
        J Matern Fetal Neonatal Med. 2016; 29: 1421-1424
        • Labarca-Acosta M
        • Reyna-Villasmil E
        • Aragón-Charris J
        • Santos-Bolívar J
        Pancreatic adenocarcinoma during pregnancy.
        Cir Esp. 2015; 93: 475-477
        • Davis J
        • Bashir S
        • Wubneh H
        • Borum ML
        Metastatic pancreatic adenocarcinoma during pregnancy.
        ACG Case Rep J. 2016; 3: e190
        • Şahin Aker S
        • Katlan DC
        • Yüce T
        • Söylemez F
        Placental, hepatic, and supraclavicular lymph node metastasis in pancreatic adenocarcinoma during pregnancy: A case report.
        Turk J Obstet Gynecol. 2016; 13: 161-163
        • Aynıoğlu Ö
        • Ergin RN
        • Çakırog Lu YI
        • Çalışkan E
        Pregnancy with concomitant pancreatic cancer.
        Proc (Bayl Univ Med Cent). 2017; 30: 289-290
        • Wakefield BW
        • Masterson CMC
        • Borges MT
        • Hurt KJ
        Pancreatic cancer in pregnancy presenting with thromboembolic events: case report and review of the literature.
        Gynecol Obstet Investig. 2018; 83: 404-409
        • Shi AW
        • Shen XF
        • Ding HJ
        • Liu YQ
        • Meng L
        • Kalionis B
        Pancreatic carcinoma underlying a complex presentation in late pregnancy: a case report.
        J Med Case Rep. 2018; 12: 369
        • Joshi U
        • Upadhaya SR
        • Agrawal V
        • Rana A
        Pancreatic tumors complicating pregnancy: a concern for fetomaternal well being.
        Int Med Case Rep J. 2020; 13: 255-259
        • Hanbidge AE
        Cancer of the pancreas: the best image for early detection-CT, MRI, PET or US?.
        Can J Gastroenterol. 2002; 16: 101-105
        • Niedowicz DM
        • Daleke DL
        The role of oxidative stress in diabetic complications.
        Cell Biochem Biophys. 2005; 43: 289-330
        • Dawson SI
        Long-term risk of malignant neoplasm associated with gestational glucose intolerance.
        Cancer. 2004; 100: 149-155
        • Jee SH
        • Ohrr H
        • Sull JW
        • Yun JE
        • Ji M
        • Samet JM
        Fasting serum glucose level and cancer risk in Korean men and women.
        JAMA. 2005; 293: 194-202
        • Fisher WE
        • Boros LG
        • Schirmer WJ
        Insulin promotes pancreatic cancer: evidence for endocrine influence on exocrine pancreatic tumors.
        J Surg Res. 1996; 63: 310-313