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CASE REPORTS
SARCOMA BOTRYOIDES OF THE UTERINE CERVIX IN A YOUNG GIRL
A 14-year-old girl with Subnormal Intelligence presented with
continuous heavy menstrual bleeding for one and a half months, not
responding to Progesterone Therapy. Her previous cycles were regular.
Acanthosis nigricans and obesity were the only positive findings
on systemic examination. Local examination was noncontributory.
Investigations revealed, diabetes and anemia. Ultrasound revealed
Polycystic appearance of ovaries, but no other structural abnormality.
She was started on oral metformin and oral contraceptive pills and
once the bleeding regularised, oral contraceptive pills was tapered
off. Meanwhile, she started having a foul smelling greenish discharge
which continued despite a course of antibiotics.
A repeat ultrasound was done to rule out any growth in vagina and
it revealed a collection in lower uterine segment, cervix and upper
vagina which was suspected to be hematocolpos. MRI also confirmed
this and the patient was admitted for examination under anesthesia.
On separating labia, a polypoidal, discolored lesion was seen at the
introitus which on further examination was a large grape like, necrotic, The disease has been reported to have very poor prognosis, with a
PYELOLYMPHATIC LEAK
A 74 year old male from Bihar presented with complaints of
chylohaematuria – two episodes for last three days. He gave a history
of recurrent such attacks from last 40 years, especially after fatty
meal. His general examination and biochemical parameters were
within normal limits and his urine examination revealed 4-6 red blood
cells/high power field.
On CT Urography, bilateral kidneys were of normal size and density.
Urinary bladder was normally appreciated. However, note was made
of tubular structures/fat stranding along left renal vein. These tubular a careful physical examination to look
structures were not showing enhancement in the arterial phase or
venous study. Delayed images showed same density in these tubular
structures as the pelvis of pelvicalyceal system. These changes
were seen to extend to lumbar 3-4 level. Findings are suggestive
of pyelolyphatic flow due to occluded lymphatics and associated
retrograde flow to the pelvis , presenting as chyluria.This patient was
refered for CT Urology by Dr. M S Jha (Urologist).
Discussion:- Chyluria is one of the late manifestations of filariasis and
has been reported to occur 1 month to 54 years (average 20 years)
after the acute filarial infestation. Chyluria occurs because of rupture
Printed & Published by Mr. Kamal Solanki on behalf All India Society for Health Aid Education & Research (A.S.H.A) Editor : Dr. Renu Madan Date of Printing-27th April 2017
and printed at Bagri Printers, Published from Venkateshwar Hospital, Sector -18A, Dwarka, New Delhi – 110075.
firm growth (fig 1.) filling the whole of the vagina, the upper limit of which
was not delineated. The anterior lip of cervix was felt and the growth
appeared to have its origin from the uterine cervix. Posterior upper
limit could not be felt. On per rectal examination, rectal mucosa and
parametrium were free. Decision was taken to take biopsy from lower
end of polyp to establish a histopathological diagnosis. HPE confirmed
the lesion to be Sarcoma Botryoides - Embryonal Rhabdomyosarcoma
which was confirmed on extended immunohistochemistry. A PET CT
did not reveal any metastasis. A combined multidisciplinary team
took the decision to start chemotherapy followed by surgery or
radiotherapy. The child has tolerated the first cycle of chemotherapy
well. Rhabdomyosarcoma (RMS) is the most common soft tissue
sarcoma in childhood and young adulthood and accounts for
4 to 6% of all malignancies in children. Sarcoma botryoides, a variant
of embryonal rhabdomyosarcoma, is the most common neoplasm of
the lower genital tract in girls under 16 years of age. The patients
generally belong to the age 12 to 26 years, with a mean of 18 years.
five year survival rate between 10 and 35%.
Dr. Monika Bhatia
MBBS, MS (Obs & Gynae),
MRCOG (RCOG) London (UK)
(Gold Medalist), DNB ( Obs, DIP in
USG, DCH)
Consultant
Obstetrics & Gynaecology
of lymph vessels as a result of retrograde
lymphatic hypertension and dilatation in
the urinary tract. It is usually associated
with abnormal retrograde or collateral flow
of lymph from intestinal lymphatics into the
lymphatics of the kidney, ureter, or bladder.
The diagnosis depends mainly on a
careful history, a high index of suspicion,
for lymphadenopathy, lymphangitis, and
swelling of the extremities but in our case
CT urography was diagnostic. Radiologically
these communications are very rarely so well
appreciated as was seen in our case.
Dr. Rakhee Gogoi
MD, F.R.C.R
Sr Consultant & HOD
Radiology & Imaging
For more information, please call
Sector 18 A, Dwarka, New Delhi-110075
www.venkateshwarhospitals.com
Date of Publishing-30th April 2017