Introduction
Leiomyosarcomas are rare and aggressive malignant mesenchymal tumours resistant to conventional chemotherapy. Leiomyosarcoma complicating pregnancy is an extremely rare occurrence.
The following cases highlight the complex management and outcomes of two women with metastatic leiomyosarcoma in the postnatal period.
Case presentation
Two multigravida women in their late thirties presented with worsening pain during their second pregnancies. Metastatic leiomyosarcoma was diagnosed postpartum with histological and radiological findings. Patient-A had stage IV retroperitoneal leiomyosarcoma with pulmonary and hepatic metastases, while Patient-B had stage IIIa uterine leiomyosarcoma with pulmonary metastasis. Delivery in both patients was by emergency cesarean section ; Patient-A delivered a healthy infant at 39+2 weeks, while Patient-B delivered an infant at 29+3 weeks who remained in the neonatal intensive care for two months due to complications of prematurity.
Following delivery, Patient-A received six cycles of doxorubicin and Patient-B underwent debulking surgery followed by six cycles of doxorubicin and ifosphamide.
Outcomes
Patient-A experienced recurrent hip pain two months after completing chemotherapy. CT scans four months later confirmed disease recurrence. Palliative radiotherapy was commenced, followed by four cycles of ifosphamide. Pazopanib was then initiated. This patient is still alive at 17 months from diagnosis.
Patient-B had recurrence of metastatic disease six months after completing chemotherapy and surgery. Letrozole was commenced, but ceased when further disease progression was identified. Five cycles of gemcitabine and docetaxel were then administered, followed by further surgical debulking of intra-abdominal tumour. Oral cyclophosphamide was commenced, but ceased when further disease progression was again identified. Patient-B was subsequently enrolled in a clinical trial; however she developed complications following one cycle. This patient passed away two months later, almost two years from the date of diagnosis.
Conclusion
These cases highlight the complexity of management and the psychological impact on the women with newborn babies.