Musculoskeletal Tumors in Extremities Diagnosed During the Gestational Period: Case Series and Literature Review

Given the low incidence of musculoskeletal tumors during pregnancy, publications on the subject are scarce and treatment guidelines nonexistent. We present five cases of musculoskeletal tumors in pregnant women, three with metastasizing malignant neoplasms and two with aggressive giant cell tumors. The three patients diagnosed during their gestational period were operated before the end of pregnancy, adapting surgical techniques to minimize risk to mother and fetus. Adjuvant therapies were postponed until the end of gestation. All newborns were delivered at term vaginally, except for one where a cesarean section was required. After a mean follow-up of 69.96 months (±56.38), all patients were free of disease, except for the one diagnosed with an extraskeletal myxoid chondrosarcoma who died at 4 years from diagnosis. Surgery plays a key role in the treatment of musculoskeletal tumors diagnosed during pregnancy. These patients must be treated by multidisciplinary teams at sarcoma reference hospitals, involving the obstetrics team in the decision-making process, and adapting each step of the diagnosis and treatment to the gestational period. Key words: pregnancy, musculoskeletal tumors, sarcoma, cancer, oncological surgery.

Soft tissue sarcomas in the elbow region and influence of their anatomical features in their treatment. Experience in the Unit of Musculoskeletal Tumours

BACKGROUND AND AIM

Soft tissue sarcomas are exceptionally located in the elbow region. The aim of this work was to study the soft tissue sarcomas of the elbow region, their epidemiological and histopathological characteristics, anatomical features, the treatment performed, and the results obtained, in a unit of musculoskeletal tumours.

METHODS

Retrospective review of ten patients with a mean follow-up of 65.0 ± 11.9 (range 21-132) months with soft tissue sarcomas located in the elbow region operated in our centre between 2008 and 2016.

RESULTS

Mean age was 60.8 ± 6.7 years. Undifferentiated pleomorphic sarcoma was the most frequent histological diagnosis. Limb preservation surgery was performed in 90% of patients. Three patients were previously operated without following surgical oncology guidelines in another hospital, and this was statistically related to the need for more than one surgery to control the disease. R1 margin was obtained in 5 patients and R0 in another 5. Adjuvant radiotherapy was used in 7 cases. In 4 patients, subsequent surgery was performed for local or systemic control of the disease. Local recurrence occurred in 3 cases and in 5 there was distant disease.

CONCLUSION

The elbow region presents difficulty in achieving wide margins due to the proximity of neurovascular structures, adjuvant and / or neoadjuvant therapies could play an important role in performing limb preservation surgery. It would be advisable to refer these tumours to specialized units with multidisciplinary teams.