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A COMMON TUMOR AT AN UNCOMMON SITE

Exploring a rare vulval tumor in a 50-year-old woman with postmenopausal bleeding; detailed history, physical examination, and diagnostic findings presented.

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A COMMON TUMOR AT AN UNCOMMON SITE

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  1. A COMMON TUMOR AT AN UNCOMMON SITE Case Presentation By Dr. MariamZahir Post Graduate Trainee Department Of Obstetrics and Gynaecology Benazir Bhutto Hospital

  2. PATIENT PROFILE • Mrs. XYZ • 50 years female • No formal education • House wife • Divorced for the last 14 years • Resident of Attock • Date of Admission: 11-8-16 • Mode of Admission: OPD

  3. PRESENTING COMPLAINTS • Swelling over the vulval region for last 10 years • Postmenopausal bleeding for last 1 month

  4. HISTORY OF PRESENT ILLNESS • The patient was in her usual state of health when she started noticing a mass at introitus 10 years back. • Initially it was small then gradually increased in size. • There were no associated urinary and bowel complaints. • History of post menopausal bleeding for last one month.

  5. GYNAECOLOGICAL HISTORY • Menarche : 12 years • Menstrual cycle: Previous cycle 7/28 days, regular, average blood flow. • No history of dysmenorrhea , dyspareunia, postcoital bleeding or intermenstrual bleeding • Never practiced any contraception.

  6. GYNAECOLOGICAL HISTORY Cont…. • No history of PAP smear • Menopause: 2 years back at the age of 48 years. • Post menopausal bleeding: 1 month

  7. OBSTETRICAL HISTORY • Patient is P4+1 • All uneventful spontaneous vaginal deliveries at home. • One son and three daughters. • Last child birth 21 years back. • Last miscarriage 15 years back followed by ERPC.

  8. Past Medical History: Not significant • Past Surgical History: Not significant • Family History: No history of breast, colon and ovarian malignancy • Drug History: No history of anticoagulant intake or HRT • Systemic Inquiry: Non-significant

  9. GENERAL PHYSICAL EXAMINATION • A lady of average built well oriented in time and space. • Vital signs: • Pulse : 88/min • BP : 110/70 mm Hg • Temp: 98.6 o F • Respiratory rate: 16/min

  10. GENERAL PHYSICAL EXAMINATION Cont... • Pallor : -ve • Weight: 48 Kg • Height : 155 cm • BMI: 20 Kg/m2

  11. SYSTEMIC EXAMINATION • ABDOMINAL EXAMINATION: Soft non tender, no mass palpable • CARDIOVASCULAR SYSTEM: Normal heart sounds, No added sounds. • RESPIRATORY SYSTEM: Normal vesicular breathing. • CENTRAL NERVOUS SYSTEM: Grossly intact

  12. LOCAL EXAMINATION

  13. INVESTIGATIONS

  14. ULTRASOUND OF MASS • A hypoechoic solid mass measuring 6 x 8cm with no calcifications. • Peripheral area more echogenic than central relatively anechoic area

  15. TRANSVAGINAL ULTRASOUND • Uterus 6x4x3.5 cm • Endometrial echo 4 mm • Bilateral adenexa normal

  16. For further evaluation Examination Under Anesthesia and Cystoscopy was planned.

  17. EXAMINATION UNDER ANESTHESIA(EUA) • A 6 X 8 cm firm mass at introitus. • A 4x5 cm ulcer at the most dependent part. Ulcer

  18. EXAMINATION UNDER ANESTHESIA(EUA)

  19. EXAMINATION UNDER ANESTHESIA(EUA)

  20. EXAMINATION UNDER ANESTHESIA(EUA) SPECULUM EXAMINATION : • Cervix normal looking. • Vagina normal looking and free of mass. • PAP smear taken. BIMANUAL EXAMINATION: • Uterus 6 week size, mobile with bilateral adenexa clear Normal Cervix

  21. EXAMINATION UNDER ANESTHESIA(EUA) • Urethra deviated to 2 o’ clock position. • Patient was catheterized to ascertain path of urethra

  22. CYSTOSCOPY • Date: 22 October,2016 • Surgeon : Prof. Dr. Mumtaz assisted by Dr Zeeshan • Findings:. Urethral opening was normal. Bladder was trabeculated. No communication of mass into urethra and bladder seen.

  23. CYSTOSCOPY VIDEO

  24. MICTURATING CYSTOURETHROGRAM Left Oblique View: Urethra deviated towards left side.

  25. MRI PELVIS

  26. MRI PELVIS

  27. TREATMENT Excision and enucleation of the mass was planned.

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