Temporal Bone Osteosarcoma in Pregnancy: A Case Report and Literature Review

Introduction Osteosarcoma is the most common primary malignant bone tumor; however, involvement of the temporal bone is exceptionally rare, particularly during pregnancy. The coexistence of malignancy and pregnancy presents unique diagnostic and therapeutic challenges requiring multidisciplinary management. Case Presentation A 23-year-old woman presented with persistent right otalgia and an external auditory canal lesion initially diagnosed as cholesteatoma. Following surgical resection, final histopathology revealed temporal bone osteosarcoma with early locoregional recurrence and intracranial extension. Pregnancy was incidentally diagnosed during oncologic evaluation at 24 weeks of gestation. Given the aggressive nature of the tumor, pregnancy termination followed by palliative chemotherapy was initially recommended; however, the patient elected to continue the pregnancy after multidisciplinary counseling. She received chemoradiotherapy with ifosfamide/mesna and 40 Gy radiotherapy. Subsequently, severe anhydramnios and early fetal growth restriction developed, likely secondary to fetal nephrotoxicity associated with ifosfamide exposure. A cesarean section was performed after antenatal corticosteroid administration, resulting in the delivery of a live preterm neonate admitted to the neonatal intensive care unit, and discharged after 58 days of hospitalization. Conclusion Temporal bone osteosarcoma during pregnancy is exceedingly rare and requires complex multidisciplinary management balancing maternal oncologic treatment and fetal risks.