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Two cases show fetus can get lung cancer during delivery if mother has cervical cancer

The New England Journal of Medicine
Reuters Health - 06/01/2021 - Doctors in Japan say they have uncovered two cases where young children developed lung cancer after acquiring cervical-cancer cells from their mothers during delivery.

The team used next-generation genetic-sequencing techniques to link the child tumors to the mother's cervical cancer which, in one case, had not been diagnosed at the time of delivery.

"Cesarean section should be recommended for mothers with uterine cervical cancer," first author Dr. Ayumu Arakawa of the National Cancer Center Hospital in Tokyo told Reuters Health by email.

Since 1949, there have been at least 18 documented cases where a child has transplacentally acquired cancer from the mother prior to delivery. All of the children were under age 2 and their tumors can appear throughout a child's body.

Although about one in 1,000 babies are delivered by a mother with cancer, having the fetus acquire the tumor is believed to happen only once in every half million pregnant women with cancer.

In the two new cases, reported in the New England Journal of Medicine, the boys were ages 23 months and 6 years.

"The transmission was demonstrated by the fact that the tumors in both male children lacked the Y chromosome and shared multiple somatic mutations," a human papilloma virus genome and single-nucleotide polymorphism alleles with tumors from the mothers, the researchers note. "The peribronchial pattern of tumor growth in both children suggested that the tumors arose from mother-to-infant vaginal transmission through aspiration of tumor-contaminated vaginal fluids during birth."

"In our two patients, tumors were observed only in the lungs and were localized along the bronchi," the team notes. "It is likely that maternal tumor cells were present in the amniotic fluid, secretions, or blood from the cervix and were aspirated by the infants during vaginal delivery."

The tumors in the 23-month-old boy were diagnosed after he suffered from a productive cough for two weeks. A CT scan spotted the masses. The mother had been diagnosed with squamous-cell carcinoma of the cervix when the baby was 3 months old.

Initially, the child was not treated. By age 3 some of the lesions had regressed but the tumor had also spread along the bronchi. Two chemotherapy regimens failed. Treatment with nivolumab produced a complete response and the child was cancer free in a CT scan last month, said Dr. Arakawa. The mother died.

The 6-year-old boy was initially hospitalized for left-side chest pain and a 6 cm mass was discovered. His mother had been diagnosed with a cervical polypoid tumor when she was pregnant, but she delivered vaginally because her tumor was stable and cytologic analysis was negative.

Three months after the birth, she received a radical hysterectomy and bilateral salpingo-oophorectomy. She died two years after the surgery.

When the 6-year-old's cancer appeared, "We suspected transmission of maternal cancer to the boy because we had already experienced maternal-to-infant" transmission in the case of the 2-year-old, Dr. Arakawa said.

The child, after repeated chemotherapy and one recurrence, underwent a total left pneumonectomy. After 15 months of follow-up he remains free of disease and was last checked last month.

Dr. Arakawa said his team "will further continue to carefully examine pediatric lung and other cancers in daily medical care to understand the prevalence of this transmission."

SOURCE: https://bit.ly/2WYmC7Y The New England Journal of Medicine, online January 7, 2021.

By Gene Emery

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