{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:00:40Z","timestamp":1790269240393,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Carcinosarcomas are highly aggressive tumors with both carcinomatous and sarcomatous components, typically arising from the female genital tract. Primary retroperitoneal carcinosarcomas are extremely rare, and their occurrence during pregnancy presents major clinical and ethical challenges. Case Presentation: We report a case of a 24-year-old primigravida diagnosed with a large encapsulated retroperitoneal mass at 12 weeks of pregnancy, initially presenting with abdominal pain. The patient declined medical advice for pregnancy termination and chose to continue despite oncological risks. A multidisciplinary team planned delayed surgery after delivery. At 34 weeks, a cesarean section resulted in a healthy newborn, but surgical exploration revealed an inoperable, invasive tumor. The patient died two days later from postoperative complications. Autopsy confirmed widespread tumor invasion and lung metastases consistent with primary retroperitoneal carcinosarcoma. Conclusions: This case highlights the challenges of managing aggressive malignancies during pregnancy, emphasizing early diagnosis, multidisciplinary care, and ethical decision-making while respecting patient autonomy.<\/jats:p>","DOI":"10.3390\/diagnostics15243228","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T10:41:23Z","timestamp":1765968083000},"page":"3228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic and Ethical Challenges in a Rare Case of Retroperitoneal Carcinosarcoma During Pregnancy\u2014A Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Marius Florentin","family":"Popa","sequence":"first","affiliation":[{"name":"Preclinical Sciences Department, Faculty of Medicine, Ovidius University of Constan\u021ba, 900470 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9660-0848","authenticated-orcid":false,"given":"Mihaela Lavinia","family":"Mihai","sequence":"additional","affiliation":[{"name":"Forensic Medicine Department, County Clinical Emergency Hospital of Constan\u021ba, 900591 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Draguta","family":"Tabirca","sequence":"additional","affiliation":[{"name":"Forensic Medicine Department, County Clinical Emergency Hospital of Constan\u021ba, 900591 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9251-3297","authenticated-orcid":false,"given":"Mariana","family":"Deacu","sequence":"additional","affiliation":[{"name":"Preclinical Sciences Department, Faculty of Medicine, Ovidius University of Constan\u021ba, 900470 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9131-8617","authenticated-orcid":false,"given":"Sorin","family":"Vamesu","sequence":"additional","affiliation":[{"name":"Pathology Department, County Clinical Emergency Hospital of Constan\u021ba, 900591 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9680-0384","authenticated-orcid":false,"given":"Daniel Ioan","family":"Ureche","sequence":"additional","affiliation":[{"name":"Discipline of Forensic Medicine, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-4731","authenticated-orcid":false,"given":"Vlad Iustinian","family":"Tica","sequence":"additional","affiliation":[{"name":"Preclinical Sciences Department, Faculty of Medicine, Ovidius University of Constan\u021ba, 900470 Constan\u021ba, Romania"},{"name":"Romanian Academy of Scientists, 050045 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Otsuka, I. (2023). Primary Retroperitoneal Carcinomas: New Insights into Pathogenesis and Clinical Management in Comparison with Ovarian Carcinomas and Carcinoma of Unknown Primary. Cancers, 15.","DOI":"10.3390\/cancers15184614"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Choi, J.H., and Ro, J.Y. (2020). Retroperitoneal Sarcomas: An Update on the Diagnostic Pathology Approach. Diagnostics, 10.","DOI":"10.3390\/diagnostics10090642"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"470795","DOI":"10.1155\/2011\/470795","article-title":"Uterine carcinosarcomas (malignant mixed m\u00fcllerian tumours): A review with special emphasis on the controversies in management","volume":"2011","author":"Kanthan","year":"2011","journal-title":"Obstet. Gynecol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e100037","DOI":"10.1200\/EDBK_100037","article-title":"Patient-Centered Care in the Management of Cancer During Pregnancy","volume":"43","author":"Sorouri","year":"2023","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/ijgc-2023-004609","article-title":"Staging by imaging in gynecologic cancer and the role of ultrasound: An update of European joint consensus statements","volume":"34","author":"Fischerova","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_6","first-page":"321","article-title":"The valid evidence to reveal the effect of sex hormone on primary retroperitoneal malignant mixed m\u00fcllerian tumor: A case report","volume":"40","author":"Sun","year":"2019","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.ygyno.2004.01.018","article-title":"Retroperitoneal m\u00fcllerian carcinosarcoma associated with endometriosis: A case report","volume":"93","author":"Booth","year":"2004","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/ijgc-2023-004429","article-title":"ESGO\/ESTRO\/ESP Guidelines for the management of patients with cervical cancer\u2014Update 2023*","volume":"33","author":"Cibula","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1055\/s-0029-1215428","article-title":"Pregnancy and Genital Sarcoma: A Systematic Review of the Literature","volume":"26","author":"Matsuo","year":"2009","journal-title":"Am. J. Perinatol."},{"key":"ref_10","first-page":"195","article-title":"Primary retroperitoneal tumor during pregnancy: Case report and review of the literature","volume":"71","author":"Sierra","year":"2020","journal-title":"Rev. Colomb. Obstet. Ginecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e243639","DOI":"10.1136\/bcr-2021-243639","article-title":"Case of a huge recurrent retroperitoneal liposarcoma diagnosed in the second trimester of pregnancy","volume":"14","author":"Li","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_12","first-page":"9982171","article-title":"A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy","volume":"2021","author":"Sipe","year":"2021","journal-title":"Case Rep. Oncol. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3471","DOI":"10.1002\/cam4.4707","article-title":"Pregnancy outcomes related to the treatment of sarcomas with anthracyclines and\/or ifosfamide during pregnancy","volume":"11","author":"Miller","year":"2022","journal-title":"Cancer Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Schmitz, E., and Nessim, C. (2022). Retroperitoneal Sarcoma Care in 2021. Cancers, 14.","DOI":"10.3390\/cancers14051293"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ijscr.2015.01.002","article-title":"A case of retroperitoneal liposarcoma after delivery with expression of estrogen receptor: Report of a case","volume":"7","author":"Kasashima","year":"2015","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1007\/s13193-022-01520-y","article-title":"Retroperitoneal Sarcomas: A Current Review on Management","volume":"13","author":"Patkar","year":"2022","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.5858\/arpa.2014-0061-RA","article-title":"Immunohistochemistry in Undifferentiated Neoplasm\/Tumor of Uncertain Origin","volume":"138","author":"Lin","year":"2014","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.5858\/arpa.2022-0459-RA","article-title":"Current Approach to Undifferentiated Neoplasms, With Focus on New Developments and Novel Immunohistochemical Stains","volume":"147","author":"Borch","year":"2023","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_19","first-page":"91","article-title":"Short and long-term outcomes of endometrial cancer and atypical endometrial hyperplasia management in young women","volume":"43","author":"Arko","year":"2022","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yajnik, S. (2019). Landmark Trials in Selected Adult Soft Tissue Sarcomas BT\u2014Landmark Trials in Oncology, Springer International Publishing.","DOI":"10.1007\/978-3-030-14405-0"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1136\/ijgc-2019-000356","article-title":"Guidelines for perioperative care in gynecologic\/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations\u20142019 update","volume":"29","author":"Nelson","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"vii303","DOI":"10.1093\/annonc\/mdq278","article-title":"Cancer of unknown primary site: 20 questions to be answered","volume":"21","author":"Pavlidis","year":"2010","journal-title":"Ann. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/24\/3228\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T10:53:03Z","timestamp":1765968783000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/24\/3228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":22,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["diagnostics15243228"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15243228","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]}}}