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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Full-term pregnancy in breast cancer survivor with fertility preservation: A case report and review of literature
Marta Garrido-Marín, Pedro Maria Argacha, Luís Fernández, Florencia Molfino, Fina Martínez-Soler, Avelina Tortosa, Pepita Gimenez-Bonafé
Marta Garrido-Marín, Pepita Gimenez-Bonafé, Department of Physiological Sciences, Physiology Unit, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
Pedro Maria Argacha, Hospital Universitari General de Catalunya, Barcelona 08190, Spain
Luís Fernández, Servicio de Oncología Médica, Consorcio Corporación Sanitaria Parc Taulí, Barcelona, Sabadell 08208, Spain
Florencia Molfino, Instituto de Reproducción Cefer, Barcelona 08017, Spain
Fina Martínez-Soler, Avelina Tortosa, Department of Basic Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
Author contributions: Garrido-Marín M was in charge of collecting the data from the different centers involved in the case report and wrote the manuscript; Argacha PM, Fernández L, and Molfino F collected the data from their files and helped with the chronological organization of all the clinical events of the patient; Martínez-Soler F and Tortosa A revised the manuscript; Gimenez-Bonafé P generated the final version of the manuscript, collected and organized the data, and revised the manuscript.
Supported by grants from the Instituto Carlos III, Nos. PI 11/01377 and ISCIII-RETICRD12/0036/0029; Government of Catalonia, No. 2017SGR-1014.
Informed consent statement: The patient authorized the medical team to write up her clinical history and allowed for the data and clinical photographs to be published. Her identity is protected throughout the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist-2016.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Pepita Gimenez-Bonafé, BsC, BSc, MSc, PhD, Senior Research Fellow, Full-time Professor and Scientist, Department of Physiological Sciences, Universitat de Barcelona, Carrer Feixa Llarga, s/n, L’Hospitalet de Llobregat, Barcelona 08907, Spain. pgimenez@ub.edu
Telephone: +34-934-039727 Fax: +34-934-024268
Received: July 13, 2018
Peer-review started: July 13, 2018
First decision: October 8, 2018
Revised: November 20, 2018
Accepted: November 30, 2018
Article in press: December 1, 2018
Published online: January 6, 2019
ARTICLE HIGHLIGHTS
Case characteristics
Full-term pregnancy success in a 43-year-old woman treated with chemotherapy and hormonotherapy for breast cancer who also had having several gynecological problems.
Clinical diagnosis
Endometriosis, ovarian cyst, hydrosalpinx, submucosal myomas, breast cancer, and in vitro fertilization.
Differential diagnosis
Laparoscopy, lymphadenectomy, chemotherapy, radiotherapy, and hormonotherapy.
Laboratory diagnosis
Biopsy evidencing a human epidermal growth factor receptor 2-positive hormone-dependent (80% estrogenic receptors, 70% progestational receptors) CD56 negative high grade invasive ductal carcinoma.
Imaging diagnosis
Ultrasound and Doppler showing ovarian cystic tumors, hydrosalpinx, and breast cancer tumor.
Pathological diagnosis
Pathological diagnosis showed a pT1bpN1a, stage IIA breast cancer tumor. Diagnostic hysteroscopy showed two small submucosal myomas.
Treatment
Chemotherapy based on Epirubicin and Cyclophosphamide, followed by Docetaxel and Trastuzumab; Hormonotherapy based on Tamoxifen followed by subcutaneous Trastuzumab; Radiotherapy; Oral contraception based on Suavuret® (Desogestrel and EthinylEstradiol); Uterine endometrium preparation based on Progynova® (equivalent to EstradiolValerate).
Related reports
The probability of natural pregnancy in a fertile woman is approximately 20%. With age and health problems such as gynecological or/and oncological, this percentage drops significantly. This case serves to maintain hope in women in a similar situation who wish for motherhood.
Term explanation
Successful pregnancy achieved (with healthy baby born) with only one in vitro fertilization procedure, using a single vitrified embryo at age 39, and transferred at age 43.
Experiences and lessons
This is a special clinical case of a patient with theoretically low pregnancy success, probably due to the consecutive accumulation of gynecological and oncological pathologies, who became pregnant and delivered a full-term infant with adequate breastfeeding.
