Errol Hutagalung1, Made Agus Mahendra Inggas2, Henry Riyanto Sofyan3, Anne Dina Soebroto3, Jessica Herlambang4, Jeffry Beta Tenggara5, Alvin Setiawan6, Christine Banjarnahor7, Joyce Bratanata8, Ribka Bella Simorangkir4
1Department of Orthopaedics and Traumatology, MRCCC Siloam Hospitals, Jakarta, Indonesia;
2Department of Neurosurgery, MRCCC Siloam Hospitals, Jakarta, Indonesia;
3Department of Neurology, MRCCC Siloam Hospital, Jakarta, Indonesia;
4MRCCC Siloam Hospitals, Jakarta, Indonesia;
5Department of Hematology and Oncology, MRCCC Siloam Hospitals, Jakarta, Indonesia;
6Department of Obstetrics and Gynecology, MRCCC Siloam Hospitals, Jakarta, Indonesia;
7Department of Oncology Radiation, MRCCC Siloam Hospitals, Jakarta, Indonesia;
8Department of Tropical Infectious Diseases, MRCCC Siloam Hospitals, Jakarta, Indonesia
Correspondence to: Errol Hutagalung, MD. Department of Orthopaedics and Traumatology, MRCCC Siloam Hospitals, Garnisun Street, Jakarta 12930, Indonesia. Email: jessica.herlambang@gmail.com.
Background: Advanced cancer cases in pregnant patients present complex medico-legal and ethical challenges. We present a case of advanced leiomyosarcoma during pregnancy and its medico-legal aspect. It aims to provide insights into navigating these issues and improving decision-making frameworks for similar cases.
Case Description: A 22-year-old pregnant female at 18 weeks gestation presented with a complaint of a left thigh mass. The patient experienced continuous moderate-severe pain throughout the left thigh and headache accompanied by vomiting. Physical examination revealed somnolence, eyelid ptosis, and ophthalmoplegia of the left eye. The left femoral exhibited erythema, edema, and restricted range of motion due to pain. Femur magnetic resonance imaging (MRI) revealed a pathological mid-femoral fracture secondary to infiltrative soft tissue mass, with multiple inguinal lymphadenopathy metastases. Brain MRI without contrast identified multiple masses in the right frontal and left temporal regions causing significant intracranial mass effect prompting craniotomy for tumor removal. A needle biopsy of the thigh mass confirmed leiomyosarcoma. The patient's consciousness improved after the surgery but suddenly deteriorated a few days later, brain scan without contrast showed an increased size and mass effect of the left temporal lesion. Whole-brain radiation therapy was initiated, but the patient’s condition worsened and the fetus also exhibited intrauterine growth restriction and severe oligohydramnios due to cancer progression. Both the patient and fetus succumbed to the disease.
Conclusions: This case underscores the challenges in managing intracranial metastasis in pregnancy, necessitating a multidisciplinary approach for optimal management while minimizing harm. In this case, the ethical aspect of patient autonomy is evident as the patient and her family consented to the medical interventions, despite the risks involved. The principle of beneficence and non-maleficence is demonstrated through the medical team’s diagnostic and medical interventions aiming to prevent unnecessary harm to the patient and fetus while still providing effective care for the patient. In terms of justice, the patients get fair access to healthcare resources and treatments, regardless of socioeconomic status. Unfortunately, the patient’s condition worsened due to cancer progression. In conclusion, the case highlights the importance of respecting patient autonomy while striving to act in their best interests through beneficent medical intervention.
Keywords: Ethical dilemma; medico-legal; cancer during pregnancy; case report
