Aggressive Chemotherapy and Antepartum Management of Small Cell Carcinoma of the Ovary of Hypercalcemic Type: A Novel Case Report with Ethical and Medical Decision-Making Consideration

Background: Small Cell Carcinoma of the Ovary of Hypercalcemic Type (SCCOHT) is a rare, aggressive, and highly fatal gynecologic malignancy with few treatment guidelines offered in non-pregnant patients. Case Report: A 32-year-old woman presented for initial prenatal care at 9 weeks and her dating ultrasound was notable for a large complex adnexal mass. MRI performed 2 weeks later revealed accelerated interval growth with possible malignant etiology. She underwent surgical evaluation with salpingo-oophorectomy. Pathology noted signature features of small cell carcinoma of the ovary, hypercalcemic type (SCCOHT). The patient desired expectant management and declined termination of pregnancy or chemotherapy. Four weeks later, she developed severe abdominal pain, nausea, and vomiting, and she was diagnosed with extensive metastatic disease. After multidisciplinary and multi-institutional counseling, she elected for continuation of her pregnancy and 6-agent chemotherapy including Vinblastine, Cisplatin, Cyclophosphamide, Bleomycin, Doxorubicin, Etoposide (VPCBAE) with close antepartum surveillance. The patient completed multiple rounds of chemotherapy and subsequently delivered via primary cesarean at 27w2d due to maternal sepsis and non-reassuring fetal status. Maternal and neonatal death occurred approximately 1 week postpartum. Conclusion: This is the first known case of SCCOHT in which the pregnancy was continued through an aggressive chemotherapy regimen.