Osteosarcoma During Pregnancy: Case Report and Review of the Literature [32C]

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Abstract
To present a case report and review the literature on osteosarcoma during pregnancy 31 year old para 1 female with a prior history of cesarean delivery complained of dull pain in her right knee not relieved with rest during her 2nd trimester. Both x-ray and MRI revealed “abnormal appearance of distal femur,” possibly secondary to tumor or osteomyelitis. After multiple biopsies, she was diagnosed with high grade osteosarcoma. A subsequent CT chest showed nodules possibly representing metastasis. She underwent delivery by repeat cesarean at 29 weeks gestation after receiving antenatal steroids, as recommended by a multidisciplinary team. Her postpartum course was uncomplicated and she was discharged on post-op day 3. She began neoadjuvant chemotherapy with doxorubicin, cisplatin and ifosfamide within 4 weeks of delivery. 5 studies were identified reporting on a total of 16 patients diagnosed with osteosarcoma during pregnancy. The age range was 16 to 38. Most common presenting symptoms were pain, enlarging mass and fractures. Metastasis were identified in 9 patients. Most patients underwent vaginal delivery at term. Four patients underwent surgical resection during pregnancy. Most patients underwent chemotherapy. 6 patients eventually succumbed to the disease. Of those, one patient was diagnosed postmortem and never received treatment. Osteosarcoma in pregnancy is rare. Risks and benefits of early delivery versus delaying maternal therapy have to be weighed in an aggressive malignancy such as this. Long term maternal and neonatal outcomes have to be considered. Our experience was consistent with more recently published case reports and case series.

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