Rare Tumors in Pregnancy: A Case Report of Ewing’s Sarcoma and Systematic Review

Ewing’s sarcoma during pregnancy is a rare tumor that poses significant challenges in terms of early diagnosis and proper management. The early symptoms are often nonspecific. Management requires a tailored approach that considers multiple factors.

PubMed, Scopus, Cochrane Library and EMBASE were screened from the first record appearing up to January 2023, through Mesh Items which were related both to pregnancy and Ewing’s sarcoma. Reviewers extracted data, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement.

Fifteen papers with 15 pregnant women were included. Eleven patients were young nulliparous. The mean gestational age at diagnosis was 26 weeks. The primary sites of tumor involvement were bone, kidney and uterine cervix. One patient underwent external-beam radiation therapy (EBRT) during pregnancy. Four patients received prepartum chemotherapy (CT), resulting in healthy deliveries, except for one case of fetal death. Cesarean sections were the primary delivery method in 50% of cases, but vaginal delivery was possible in three patients (25%). Maternal mortality analysis revealed that 4 over 13 patients (30.8%) died during postpartum follow-up (FU). One patient experienced recurrence (7.7%), and eight showed no evidence of disease (61.5%). Fetal survival was 72.7%. One study reported intrauterine fetal death (9.1% of fetal mortality), whereas two patients performed induced abortion (18.2%).

The limited available data indicate that the prognosis for Ewing’s sarcoma during pregnancy is poor, with high maternal mortality. Further research is needed to understand the complex interactions between pregnancy and Ewing’s sarcoma.