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Gouveia I, Xavier M, Silva J, Martins P. Malignant tumour in pregnancy: Ewing-like sarcoma of the gluteal region. BMJ Case Rep 2024; 17:e257493. [PMID: 38649246 PMCID: PMC11043757 DOI: 10.1136/bcr-2023-257493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
We report a case of an Ewing-like sarcoma of the gluteal region with ongoing growth during the second trimester of pregnancy and noted during the third trimester. This lesion was consequently studied to infer its malignant potential. Several examinations were conducted to characterise this lesion, such as ultrasound and MR, which showed signs of tumourous invasion of the deep tissues of the gluteal region.Given that the pregnancy was at the end of the third trimester, the decision was made to schedule the delivery at 37 weeks of gestation and treat the tumour afterwards to balance maternal and fetal health.This case illustrates the need for a detailed investigation and guidance by a multidisciplinary team to provide prenatal counselling regarding a malignant tumour during pregnancy.
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Affiliation(s)
- Inês Gouveia
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Marta Xavier
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Joana Silva
- Obstetrics & Ginecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Pedro Martins
- Cirurgia Geral, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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Kyriazoglou A, Tsironis G, Liontos M, Papakosta A, Mahaira L, Thomakos N, Morphopoulos G, Papaspyrou I, Bamias A. Ewing's sarcoma of the cervix: A case report of an unusual diagnosis in pregnancy treated with surgery, adjuvant VIDE and radiotherapy. Oncol Lett 2019; 17:5529-5535. [PMID: 31186774 PMCID: PMC6507342 DOI: 10.3892/ol.2019.10267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
Ewing's sarcoma of the cervix is a rare entity and presents with considerable challenges in diagnosis and therapy. Herein, we report a case of a cervical Ewing's sarcoma presenting with FIGO stage Ib, diagnosed during the first trimester of the patient's pregnancy. Imaging with CT scans, MRI of her abdomen and PET-CT verified the locoregional extension of the tumor. The diagnosis was confirmed by immunohistochemistry and molecular analysis. Fluorescence in situ hybridization and RT-PCR detected the pathognomonic EWS/FLI fusion gene. Favorable prognostic factors regarding the stage, clinocopathological and molecular characteristics of the tumor are also described. Due to the rarity of the disease, at present, there is no universal consensus on the optimal therapeutic approach. The literature has been reviewed and the therapeutic schemes and available clinical data have been discussed. The patient presented in this case report was treated aggressively with tri-modality therapy and underwent radical hysterectomy followed by adjuvant chemotherapy with Vincristine-Ifosfamide-Doxorubicin-Etoposide and radiotherapy. The patient remains free of this disease 42 months following the diagnosis of her tumor.
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Affiliation(s)
| | - Georgios Tsironis
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
| | - Alexandra Papakosta
- Department of Genetics, Agios Savvas Hospital, Alexandra Hospital, 11528 Athens, Greece
| | - Luisa Mahaira
- Department of Genetics, Agios Savvas Hospital, Alexandra Hospital, 11528 Athens, Greece
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, Alexandra Hospital, 11528 Athens, Greece
| | | | - Irene Papaspyrou
- Department of Pathology, Alexandra Hospital, 11528 Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
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Weidema M, Kaal S, de Jong L, van Erp N, Jansen R, Schreuder B, Heidema W, van der Graaf W, Desar I. Bone sarcoma during pregnancy: an example of personalized multidisciplinary care. Acta Oncol 2019; 58:128-131. [PMID: 30264644 DOI: 10.1080/0284186x.2018.1512754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marije Weidema
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Suzanne Kaal
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loek de Jong
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nielka van Erp
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rosemarie Jansen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bart Schreuder
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wieteke Heidema
- Department of Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Winette van der Graaf
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ingrid Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Dauti A, Gerstl B, Chong S, Chisholm O, Anazodo A. Improvements in Clinical Trials Information Will Improve the Reproductive Health and Fertility of Cancer Patients. J Adolesc Young Adult Oncol 2017; 6:235-269. [PMID: 28207285 DOI: 10.1089/jayao.2016.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There are a number of barriers that result in cancer patients not being referred for oncofertility care, which include knowledge about reproductive risks of antineoplastic agents. Without this information, clinicians do not always make recommendations for oncofertility care. The objective of this study was to describe the level of reproductive information and recommendations that clinicians have available in clinical trial protocols regarding oncofertility management and follow-up, and the information that patients may receive in clinical trials patient information sheets or consent forms. A literature review of the 71 antineoplastic drugs included in the 68 clinical trial protocols showed that 68% of the antineoplastic drugs had gonadotoxic animal data, 32% had gonadotoxic human data, 83% had teratogenic animal data, and 32% had teratogenic human data. When the clinical trial protocols were reviewed, only 22% of the protocols reported the teratogenic risks and 32% of the protocols reported the gonadotoxic risk. Only 56% of phase 3 protocols had gonadotoxic information and 13% of phase 3 protocols had teratogenic information. Nine percent of the protocols provided fertility preservation recommendations and 4% provided reproductive information in the follow-up and survivorship period. Twenty-six percent had a section in the clinical trials protocol, which identified oncofertility information easily. When gonadotoxic and teratogenic effects of treatment were known, they were not consistently included in the clinical trial protocols and the lack of data for new drugs was not reported. Very few protocols gave recommendations for oncofertility management and follow-up following the completion of cancer treatment. The research team proposes a number of recommendations that should be required for clinicians and pharmaceutical companies developing new trials.
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Affiliation(s)
- Angela Dauti
- 1 College of Arts and Sciences, Department of Chemistry, New York University , New York City, New York.,2 Population Sciences Department, Dana-Farber Cancer Institute , Boston, Massachusetts.,3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Brigitte Gerstl
- 4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Serena Chong
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Orin Chisholm
- 5 Department of Pharmaceutical Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Antoinette Anazodo
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia .,4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia .,6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital , Randwick, Australia
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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; 7:581-7. [PMID: 27408761 PMCID: PMC4921935 DOI: 10.1016/j.jare.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/18/2022] Open
Abstract
Bone or soft tissue sarcomas are rarely diagnosed during pregnancy. Until today 137 well documented cases have been reported in the English literature between 1963 and 2014. Thirty-eight pregnant mothers were diagnosed with osteosarcoma, Ewing's sarcoma or chondrosarcoma, whereas 95 other cases of soft tissue sarcomas of various types have been documented. We present the clinical picture and therapeutic management of this coexistence.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - Dimitrios Petrakis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - George Fotopoulos
- Department of Medicine, Sotiria General Hospital, Athens University, Athens, Greece
| | - Sotirios Mitrou
- REA Maternity Hospital, A. Sygrou Avenue, 383, P. Faliro, Athens, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
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Berveiller P, Marty O, Vialard F, Mir O. Use of anticancer agents in gynecological oncology during pregnancy: a systematic review of maternal pharmacokinetics and transplacental transfer. Expert Opin Drug Metab Toxicol 2016; 12:523-31. [PMID: 27020922 DOI: 10.1517/17425255.2016.1167187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cancer affects one in a thousand pregnant women and gynecological cancers are one of the most frequent malignancies. Chemotherapy remains the cornerstone treatment for gynecological cancer. Although all chemotherapeutic agents can cross the placental barrier, the extent of placental transfer varies considerably. Furthermore, the significant physiological variations observed in pregnant women may have an impact on pharmacokinetic parameters. Given the complexity of predicting placental transfer, in vivo and ex vivo studies are essential in this context. In view of the paucity of data on chemotherapy during pregnancy, the objective of the present study was to summarize all the available data on the transplacental transfer of anticancer drugs used to treat gynecological cancers. AREAS COVERED In order to evaluate the in vivo and ex vivo transplacental transfer of the anticancer drugs most frequently used in gynecological malignancies, we carried out a comprehensive review of the literature published from 1967 to 2015. Lastly, we summarized recent clinical guidelines on the treatment of gynecological cancers in pregnant patients. EXPERT OPINION The preclinical and scarce clinical data must now be extrapolated to define the maternofetal toxicity/efficacy profile and thus guide the physicians to choose anticancer drugs more efficiently in this complex situation.
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Affiliation(s)
- Paul Berveiller
- a Department of Gynecology and Obstetrics , Centre Hospitalier Intercommunal de Poissy Saint Germain , Poissy , France.,b EA7404-GIG, UFR des Sciences de la Santé , Université Versailles Saint Quentin en Yvelines , Montigny-Le-Bretonneux , France
| | - Oriane Marty
- a Department of Gynecology and Obstetrics , Centre Hospitalier Intercommunal de Poissy Saint Germain , Poissy , France
| | - François Vialard
- b EA7404-GIG, UFR des Sciences de la Santé , Université Versailles Saint Quentin en Yvelines , Montigny-Le-Bretonneux , France.,c Department of Cytogenetics , Centre Hospitalier Intercommunal de Poissy Saint Germain , Poissy , France
| | - Olivier Mir
- d Department of Cancer Medicine , Gustave Roussy Cancer Campus , Villejuif , France
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Séjourné A, Paupière S, Bonnaire B, Ikoli JF, Chauffert B, Goëb V. [A peripartum lumbosciatica revealing an Ewing sarcoma of the pelvis]. ACTA ACUST UNITED AC 2013; 43:474-7. [PMID: 24315736 DOI: 10.1016/j.jgyn.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022]
Affiliation(s)
- A Séjourné
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France.
| | - S Paupière
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France
| | - B Bonnaire
- Service de radiologie, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - J-F Ikoli
- Service d'anatomie et cytologie pathologiques, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - B Chauffert
- Service d'oncologie médicale, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - V Goëb
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France; Équipe Inserm EA 4666, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France
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