Early Ultrasound Screening for Fetal Malformations in the Second Pregnancy after Combined Modality Treatment for Hodgkin’s Disease: A Case Report

Abstract

ABSTRACT Introduction: Therapeutic progress in HD has led to a high rate of cure, but at the expense of some side effects. Abnormalities reported so far are: cardiac toxicity, pulmonary toxicity, endocrinal failure, second cancers and congenital malformations. Although several studies reported in the literature showed no or slightly increased risk of congenital abnormalities among newborns of women previously treated for Hodgkin’s disease compared with the general population, abnormalities do occur and sometimes they are very odd and difficult. This is the first report of delayed appearance of specific malformations found in the literature. Case Report: We report a case of female patient, 25 years old, macedonian, presented with Hodgkin’s disease, subtype nodular sclerosis, stage IIIA. The patient received chemotherapy according to ABVD protocol – 6 cycles. Thereafter she received mantle field radiation with 3600 cGy. The first and normal pregnancy occurred after 36 months. Second pregnancy occurred 87 months after completion of treatment. At 13th gestational week ultrasound assessment revealed malformations and induced abortion was performed. A male fetus with malformations on the head such as proboscis, cyclopia and omphalocele on the front abdominal wall containing liver and small bowels was found. Conclusion: I consider this case important in bringing the potential late side-effect to the attention of both patients and doctors. They should be alert for the risk of congenital abnormalities in newborns of women previously treated for Hodgkin’s disease, especially with combined modality treatment, and should check for them during pregnancy, at birth, in early childhood, or in adulthood. Thus, odd and difficult malformations could be avoided.