Abstract
BACKGROUND: Natural conception in patients with multiple primary neoplasms (MPNs) is exceedingly rare, particularly those involving metachronous triple cancers of the reproductive, respiratory, and endocrine systems. This article reports the case of a young female patient who suffered from three primary neoplasms successively covering the three major systems of the ovary, lung, and thyroid, and achieved successful natural conception and delivery through comprehensive management by a multi-disciplinary team (MDT). This case provides a valuable reference for the diagnosis and treatment of similar patients. CASE DESCRIPTION: A 28-year-old married female underwent right ovary-preserving radical surgery for bilateral borderline serous ovarian tumors (Stage IIIB) in February 2021. She received six cycles of postoperative leuprorelin therapy. She was diagnosed with microinvasive adenocarcinoma of the left lung (Stage IA1, ERBB2 p.A775_G776insYVMA mutation) in May 2021 and underwent thoracoscopic wedge resection. The patient underwent radical surgery for papillary thyroid microcarcinoma (pT1aN0M0) in October 2022. She presented to the hospital with fertility concerns in March 2023. An MDT comprising specialists in gynecology, genetics, thoracic surgery, breast and thyroid surgery, obstetrics, and reproductive medicine held a consultation to evaluate the patient's condition. The assessment concluded that all three neoplasms were in complete remission and that pregnancy did not increase the risk of tumor recurrence. Auxiliary examination revealed an anti-Müllerian hormone level of 1.40 ng/mL (only the right ovary remained intact). Hysteroscopy confirmed the diagnosis of chronic endometritis and endometrial polyps. The polyp was resected, and the patient received a 14-day course of anti-infective therapy with metronidazole and levofloxacin, after which she was guided by natural conception. She achieved a natural pregnancy in August 2023. The MDT provided dynamic monitoring throughout the pregnancy until April 2024, when she vaginally delivered a healthy female infant weighing 3090 grams at 39 weeks and 2 days of gestation. Postpartum follow-up revealed no signs of recurrence or significant abnormalities in the offspring. CONCLUSION: This is the first case of successful natural conception and delivery in a patient with metachronous MPNs involving the reproductive, respiratory, and endocrine systems. It establishes an MDT management pathway encompassing "determination of oncologic remission status, intervention for reversible fertility-compromising factors, and cross-trimester monitoring." This confirms that natural pregnancy is safe and feasible for patients in cancer remission, with multi-disciplinary collaboration and rigorous monitoring. The absence of postpartum neoplasm recurrence and abnormalities in offspring provides a practical paradigm for fertility management in patients with MPNs.