Chemotherapy for breast cancer during pregnancy induces vascular alterations and impaired development of placental villi: A preliminary histopathological study

Alessandro Del Gobbo,Giovanna Scarfone,Fedro Alessandro Peccatori,Antonella Villa,Wally Ossola,Giulia Ercoli,Silvano Bosari,Stefano Ferrero,Francesca Laura Boggio,Elena Grossi,Fulvia Milena Cribiù

doi:10.1016/j.ejogrb.2020.04.012

Abstract

ObjectiveTo evaluate histological alterations in placentas of women affected by breast cancer and treated with chemotherapy during pregnancy. Study designWe retrospectively reviewed histological slides of 23 placentas of patients affected by breast cancer and treated with chemotherapy during pregnancy and 23 control placentas of women without breast cancer and with physiological pregnancies of the same gestational age. ResultsAll the patients had breast ductal infiltrating carcinoma, 19 of 23 cases had a G3 cancer.All patients were treated with 2–6 cycles of chemotherapy starting after 16 weeks of gestation, with different protocols.No hypertensive complications and no pre-eclampsia episodes were observed; birth weight was consistent with gestational age in all babies in both group with no uneventful outcomes and no perinatal mortality or fetal malformations.Twenty out of 23 cases (86 %) showed hypoxia-induced villous alterations, including increased syncytial knotting (Tenney-Parker changes), perivillar fibrin deposits, distal villous hypoplasia or accelerated maturation and focal villous chorangiosis. These alterations were found in 19 out of 23 controls (83 %), with no statistically significant difference between the two groups. ConclusionsThese results shows that chemotherapy in the second and third trimester of pregnancy may lead to non-specific alterations in placental vasculature and morphology.

Highlights

Cancer is detected in approximately in 1/1000 pregnant women [1], with breast cancer being the most frequent malignant tumor occurring during gestation, followed by cervical cancer, melanoma, leukemia and lymphoma [2,3,4]
The aim of this study is to examine placental morphology of patients treated with chemotherapy for breast cancer during pregnancy trying to identify peculiar histological changes and possibly to correlate them with fetal outcome
A total of 23 patients diagnosed with breast cancer and treated with chemotherapy during pregnancy that gave birth at Clinica Mangiagalli, Fondazione IRCCS Ca’ Granda – Ospedale Italy between 2004 and 2017 and 23 patients with physiological pregnancy that gave birth in the same institution in 2018 were retrospectively analyzed

Summary

Introduction

Cancer is detected in approximately in 1/1000 pregnant women [1], with breast cancer being the most frequent malignant tumor occurring during gestation, followed by cervical cancer, melanoma, leukemia and lymphoma [2,3,4]. The overall incidence of breast cancer during pregnancy varies between 2.4 to 7.3 per 100,000 [5,6,7], but it will become more common in the future due to the current trend of postponing pregnancy [8] and to a possible increase of incidence of breast cancer in young women [9,10]. Managing breast cancer during pregnancy is demanding and deserves particular attention because of the clinical and ethical implications as potentially life-saving chemotherapy for the pregnant mother may be potentially life-threatening for the developing fetus [11]. Managing breast cancer during pregnancy is very complicated and should be personalized, including a multidisciplinary team discussion balancing possible adverse maternal and fetal health impacts [1]. Chemotherapy is contraindicated during the first trimester, but has been increasingly used with good maternal efficacy thereafter [1,12,13]

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