Embryonal Rhabdomyosarcoma Causing Uterine Inversion in An Adolescent: A Rare Tumor with Rare Association
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IMAGES IN GYNECOLOGIC ONCOLOGY
Embryonal Rhabdomyosarcoma Causing Uterine Inversion in An Adolescent: A Rare Tumor with Rare Association Amita Suneja1 Kiran Mishra2
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Rashmi Malik1 • Kiran Guleria1 • Neelam B. Vaid1 • Dharam D. Varma1
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Received: 13 September 2020 / Revised: 2 November 2020 / Accepted: 11 November 2020 / Published online: 19 November 2020 Ó Association of Gynecologic Oncologists of India 2020
Summary of the case A 14-year-old girl presented with abnormal vaginal bleeding and polypoid mass in the vagina. USG & MRI revealed a large sized 9 9 5.8 9 8 cm septate collection in the vagina with inversion of uterus within this collection (Fig. 1). On examination under anesthesia, a very soft mass was felt filling the vagina, cervix was not felt and finger could be inserted all around the mass. Uterus could not be made out separate from the mass. On per rectal examination, the same mass was felt anteriorly and rectal mucosa was free. Biopsy was taken from lower portion of the growth with cold knife. Histopathology of biopsy showed mucous, bacterial colonies, anuclear squamous cells and no tumor cells. A repeat biopsy was taken from the mass with the help of cautery knife which also remained inconclusive; it revealed only fibrin clots, anucleate squamous cells and mucous. After both biopsies, there was profuse bleeding from the biopsy site which was controlled with pressure and vaginal packing. The tumor was very rapidly growing, & Amita Suneja [email protected] Rashmi Malik [email protected] Kiran Guleria [email protected] Neelam B. Vaid [email protected] Dharam D. Varma [email protected] Kiran Mishra [email protected] 1
Department of Gynecology & Obstetrics, University College of Medical Sciences (UCMS) & GTB Hospital, University of Delhi, Dilshad Garden, Delhi 110095, India
2
Department of Pathology, UCMS & GTB Hospital, Dilshad Garden, Delhi 110095, India
and in a week time it became visible at the introitus (Fig. 2) and palpable abdominally up to 12–14-week gravid uterine size. High degree of clinical suspicion of malignancy demanded a bigger biopsy which was taken with knife under anesthesia and sent for frozen section which revealed malignant mesenchymal tumor possibly embryonal rhabdomyosarcoma. Patient was given neoadjuvant chemotherapy consisting of VAC—vincristine (1.5 mg), adriamycin (50 mg) and cyclophosphamide (750 mg). On day 3 of second cycle of chemotherapy, patient had a prolapse of entire tumor mass with inverted uterus exuding profuse blood mixed discharge from its surface. (Figs. 3, 4) Patient underwent total abdominal hysterectomy after correction of the uterine inversion by Haultain method which involved cutting of the posterior constriction ring to aid the correction of the inversion in order to restore the normal anatomy. The ovaries appeared normal and were preserved. Pelvic lymphadenectomy was done till common iliac bifurcation. Para-aortic lymph nodes were not palpable and were not dissected. Postoperative period was uneventful. Histopatholog
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