A multidisciplinary approach to fertility-sparing therapy for a rare vulvar tumor.
OBJECTIVE
Case report of a young woman with a rare vulvar malignancy who received treatment with a personalized multidisciplinary approach to balance management of her malignancy without compromising survival with her desire for future pregnancy.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 33-year-old woman, gravida 2, para 1-0-1-1, who had a diagnosis of synovial cell sarcoma of the vulva and who desired future fertility.


METHODS
At multiple steps, treatment was planned to try to maximize fertility preservation without potentially affecting initial treatment, which included a radical hemivulvectomy with bilateral lymph node dissection, brachytherapy with interstitial needles (20 Gy), and external beam radiation therapy (50 Gy).


METHODS
Treatment and eradication of the malignancy and achievement of a successful subsequent pregnancy and live birth.


RESULTS
The patient had no evidence of disease for 2 years after treatment. During that time she received preconception counseling by both a perinatologist and a reproductive endocrinologist. She conceived with the use of ultrasound monitoring to time intercourse specifically with ovulation from the contralateral ovary and had an uncomplicated pregnancy with a term delivery.


CONCLUSIONS
By using several disciplines and subspecialists, this patient received personalized treatment for a rare cancer, focused at curing her cancer and optimizing her future fertility.
Dicken
Cary L
CL
Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Lieman
Harry J
HJ
Dayal
Ashlesha K
AK
Mutyala
Subhakar
S
Einstein
Mark H
MH
D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D005298:Fertility / Q000528:radiation effects; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D050498:Live Birth; D008197:Lymph Node Excision; D019060:Minimally Invasive Surgical Procedures; D010348:Patient Care Team; D011247:Pregnancy; D018714:Radiotherapy, Adjuvant; D013584:Sarcoma, Synovial / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*