Superior vena cava syndrome in third trimester in a patient with neuroendocrine carcinoma of the lung: a case report

Summary: A 36-year-old primigravida was admitted to our intensive care unit during third trimester with superior vena cava syndrome due to a mediastinal tumor. Biopsy revealed a LCNEC (Large Cell Neuroendocrine Carcinoma of the Lung) and chemotherapy with Carboplatin/Etoposide was initiated. Premature rupture of the membranes (PPROM) occurred resulting in cesarean delivery in 33+3 weeks of gestation (WoG). Following an uneventful postoperative course, oncological treatment was continued.

Clinical findings: Our 36-year-old primigravida presented in 31+4 WoG with superior vena cava syndrome and orthopnea due to first diagnosis of a mediastinal tumor. Dyspnea as a first symptom had occurred three weeks earlier.

Diagnosis: CT thorax revealed a mediastinal tumor (9x10x8cm) with multiple venous collaterals and partial obstruction of the right bronchus. Ultrasound-guided fine-needle biopsy resulted in the diagnosis of LCNEC.

Therapy: With chemotherapy/radiotherapy bearing risks for adverse pregnancy outcome and causing the dilemma of balancing maternal and fetal health, an interdisciplinary approach is key. Multidisciplinary tumor board consensus recommended immediate start of carboplatin/etoposide-based chemotherapy.

Clinical course: The patient`s symptoms improved rapidly but three days after completion of the first chemotherapy cycle, PPROM occurred (33+3 WoG). With extracorporal membrane oxygenation (ECMO) back up, vaginal birth was attempted but emergency cesarean section in epidural anesthesia was necessary. A healthy premature girl (2200g (57. percentile), Apgar score 7/9/10, UA-pH 7,30) was born. The postoperative course was uneventful. At the time of reporting, oncological treatment with four cycles of chemotherapy and radiotherapy (66Gy) has been completed, demonstrating partial response.

Interessenskonflikt

Ich erkläre als korrespondierende/r AutorIn, dass meine KoautorenInnen mir mitgeteilt haben, dass sie während der letzten 3 Jahre keine wirtschaftlichen oder persönlichen Verbindungen im oben genannten Sinne hatten. Auch ich selbst hatte keine derartigen Verbindungen in den letzten 3 Jahren.

Publication History

Article published online:
01 October 2024