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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 06

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Ginecol Obstet Mex 2021; 89 (06)

Sarcomas in pregnancy: two cases and literature review

Ibargüengoitia-Ochoa F, Lira-Plascencia J, Gallardo-Gómez F, Mustre-Juárez CR, Ruiz-Beltrán AM, Sepúlveda-Rivera CM

Language: Spanish
References: 26
Page: 497-502
PDF size: 204.43 Kb.


ABSTRACT

Background: Sarcomas are rare primary malignant neoplasms of soft tissue or bone. Since 1963, only 19 and 14 cases of pregnancy-associated Ewing sarcoma and rhabdomyosarcoma, respectively, have been reported.
Objective: To report the perinatal outcomes of two patients seen at the National Institute of Perinatology with a diagnosis of Ewing sarcoma and alveolar rhabdomyosarcoma.
Case 1: 22-year-old patient, 23 weeks pregnant, with a 20 cm tumor in the left gluteal region, with pain and difficulty in ambulation. Chest X-ray showed multiple pulmonary nodules. Magnetic resonance imaging showed a tumor in the gluteal region with extensive involvement that was diagnosed as stage IV metastatic Ewing's sarcoma. Treatment was symptomatic, with termination of pregnancy at 28 weeks.
Case 2: 22-year-old patient, 12 weeks pregnant and diagnosed with metastatic medullary syndrome. Decompression of T9-11 was performed. Upon evidencing the absence of fetal heart rate, deferred abortion was decided.
Conclusions: The definitive diagnosis of these sarcomas is established based on biopsy. The hormonal and immunologic changes of pregnancy affect their evolution and have important repercussions on adverse maternal and fetal outcomes. The care of these patients should be multidisciplinary, and advice should be given not to become pregnant until the tumor disappears.


REFERENCES

  1. Pentheroudakis G, Orecchia R, Hoekstra HJ, Pavlidis N. Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol ESMO. 2010; 21 (Suppl 5): v266-v273. https:// doi. org/10.1093/annonc/mdq198.

  2. Doyle LA. Sarcoma classification: an update based on the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone. Cancer 2014; 120 (12): 1763-74. https://doi.org/10.1002/cncr.28657.

  3. Pappo AS, Dirksen U. Rhabdomyosarcoma, Ewing sarcoma, and other Round Cell Sarcomas. Clin Oncol 2018; 36 (2): 168-79. doi:10.1200/JCO.2017.74.7402.

  4. Habboush J, Hollant L, Smart B, Single M, et al. Characteristics and patterns of rare malignancies. Rare Tumors 2016; 8 (2): 6148. https://doi.org/10.4081/rt.2016.6148.

  5. Zarkavelis G, Petrakis D, Fotopoulos G, Mitrou S, Pavlidis N. Bone and soft tissue sarcomas during pregnancy: A narrative review of the literature. J Adv Res 2016; 7 (4): 581-87. https://doi.org/10.1016/j.jare.2016.01.003.

  6. Galyfos G, Karantzikos GA, Kavouras N, Sianou A, Palogos K, Filis K. Extraosseous Ewing sarcoma: Diagnosis, prognosis and optimal management. Indian J Surg 2016; 78 (1): 49-53. https://doi.org/10.1007/s12262-015-1399-0.

  7. Grünewald TGP, Cidre-Aranaz F, Surdez D, Tomazou EM, de Álava E, Kovar H, et al. Ewing sarcoma. Nat Rev Dis Primers 2018; 4 (1): 5. doi:10.1038/s41572-018-0003-X.

  8. Maheshwari V, Farhan AS, Adreena KA. Extraskeletal osteogenic sarcoma: a rare entity. Indian J Pathol Microbiol 2008 ;51 (1): 56-57. doi:10.4103/0377-4929.40398.

  9. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104 (3): 647-51. doi:10.1097/00006250- 200409000-00053.

  10. de Haan J, Vandecaveye V, Han SN, Van de Vijver KK, Amant F. Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33: 19-32. doi: 10.1016/j.bpobgyn.2015.10.005.

  11. Wang Y, Cui J, Yan X, Jin R, Hong X. Alveolar soft part sarcoma with multiple brain and lung metastases in pregnancy: A case report and literature review. Medicine (Baltimore) 2017; 96 (46): e8790. doi:10.1097/ MD.0000000000008790.

  12. Paoluzzi L, Maki RG. Diagnosis, prognosis, and treatment of alveolar soft-part sarcoma: A Review. JAMA Oncol 2019; 5 (2): 254-60. doi:10.1001/jamaoncol.2018.4490.

  13. lysyj A, bergquist JR. Pregnancy complicated by sarcoma. Report of two cases. Obstet Gynecol. 1963; 21:506-509. file:///C:/Users/nizjo/AppData/Local/Temp/Pregnancy_ Complicated_by_Sarcoma_Report_of_Two.27.pdf

  14. Gennatas CS, Carvounis E, Fotopoulos A, Politi HD. Extraskeletal Ewing's sarcoma in a pregnant woman: a case report. Eur J Surg Oncol. 1987;13(2):163-165.

  15. Loguidice V, Tehranzadeh J, Jones E. Ewing's sarcoma and pregnancy. A case report and review of the literature. Clin Orthop Relat Res. 1986;(210):132-136. https://europepmc. org/article/med/3757352

  16. Meazza, C., Casanova, M., Zaffignani, E., Clerici, C. A., Favini, F., Vasquez, et al. An adolescent with rhabdomyosarcoma during pregnancy. Tumori. 2008;94(3):431-433. DOI: 10.1 177/030089160809400324.

  17. Siepermann M, Koscielniak E, Dantonello T, Klee D, Boos J, Krefeld B, et al. Oral low-dose chemotherapy: successful treatment of an alveolar rhabdomyosarcoma during pregnancy. Pediatr Blood Cancer. 2012;58(1):104-106. doi:10.1002/pbc.22934.

  18. Maxwell C, Barzilay B, Shah V, Wunder JS, Bell R, Farine D. Maternal and neonatal outcomes in pregnancies complicated by bone and soft-tissue tumors. Obstet Gynecol. 2004;104(2):344-348. doi: 10.1097/01. AOG.0000133502.76679.71.

  19. Molho RB, Kollender Y, Issakov J, Bickels J, Flusser G, Azem F, et al. The complexity of management of pregnancyassociated malignant soft tissue and bone tumors. Gynecol Obstet Invest. 2008;65(2):89-95. doi:10.1159/000108402.

  20. Figueiro-Filho EA, Al-Sum H, Parrish J, Wunder JS, Maxwell C. Maternal and Fetal Outcomes in Pregnancies affected by Bone and Soft Tissue Tumors. AJP Rep. 2018;8(4):343-348. doi:10.1055/s-0038-1676289.

  21. Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: disentangling treatment modalities. ESMO Open. 2016;1(3): 016. doi:10.1136/esmoopen-2015-000016.

  22. Zagouri F, Puvanesarajah V, Spiker AM, Shannon BA, Grundy M, Levin AS, Morris CD. Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor for metastatic carcinoma to bone. Surgical Oncology 2016; 25 (3): 212-22. https://doi.org/10.1016/j. suronc.2016.05.024.

  23. Lowe S. Diagnostic imaging in pregnancy: Making informed decisions. Obstet Med 2019; 12 (3): 116-22. https://doi. org/10.1177/1753495X19838658.

  24. Fridgen O, Sehovic I, Bowman ML, Reed D, Tamargo C, Vadaparampil S, et al. Contraception: The Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care. J Cancer Educ 2017; 32 (4): 924-32. https:// doi.org/10.1007/s13187-016-1003-8.

  25. Britton LE. Unintended Pregnancy: A Systematic Review of Contraception Use and Counseling in Women with Cancer. Clin J Oncol Nurs 2017; 21 (2): 189-96. doi: 10.1188/17. CJON.189-96

  26. Chabbert-Buffet N, Marret H, Agostini A, Cardinale C, Hamdaoui N, Hassoun D, et al. Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2019; 48 (7): 441-54. https://doi.org/10.1016/j. jogoh.2019.04.009.




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