Synovial sarcoma in an HIV-positive pregnant woman and review of literature

Abstract

We present a first case of synovial sarcoma in an HIV-positive pregnant woman. This 28-year-old woman was diagnosed with synovial sarcoma, a high-grade malignant soft tissue sarcoma, involving her left thigh during the first trimester of her pregnancy. She underwent surgical treatment in the form of hip disarticulation at 30 weeks’ gestation. She was subsequently delivered by emergency caesarean section (CS) at 34 weeks’ gestation when she presented with wound sepsis and a scan revealed static growth in a small for gestational age fetus. Prompt diagnosis and treatment of this aggressive tumour is important and should involve a multidisciplinary approach, with a balanced consideration of the maternal and fetal outcomes.

A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy

“…Data regarding ifosfamide use in pregnancy is particularly limited; however, Mir et al's review of ifosfamide use in pregnancy noted oligohydramnios in 5 of the 11 patients given this drug at various doses [1], suggesting this as a potential fetal toxicity and is notable in light of the borderline low AFI observed in our case that developed postifosfamide therapy. Among the cases of synovial sarcoma in pregnancy, two experienced fetal growth restriction [6,9], and one was delivered for oligohydramnios with nonreassuring fetal monitoring [11]. These constellations of findings emphasize the importance of frequent fetal monitoring during treatment in order to detect potential obstetrical complications and modify delivery planning as indicated.…”

“…In review of the literature, there have been 13 previous cases on synovial sarcoma associated with pregnancy reported [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. These patients, their treatment, and outcomes are summarized in Table 1.…”

Maternal Metastatic Synovial Sarcoma in Pregnancy

“…Synovial sarcoma account for 5-10% of all soft tissue sarcomas. 3,4 Commonly, these tumors arise in the extremities with a propensity to metastasize to the lungs. 3,4 There are no known risk factors for synovial sarcoma.…”

“…3,4 Commonly, these tumors arise in the extremities with a propensity to metastasize to the lungs. 3,4 There are no known risk factors for synovial sarcoma. [4][5][6] The standard treatment is wide surgical resection with/without radiotherapy.…”

“…but one woman was diagnosed with the disease in pregnancy. The location of primary SS in these reports is varied, with five being pulmonary, 4,8-11 three renal, [12][13][14] two head/ neck, 15,16 one abdominal wall, 17 two involving lower extremities 3,5 , and one vulvar. 18 The vulvar SS is the only published case of pre-pregnancy diagnosis, where the woman was diagnosed and treated with surgery, brachytherapy, and external beam pelvic radiation, 2 years prior to conception.…”