Case of 27 yr old woman, who came with c/o vague abdominal pain since 6 mts, increased frequency of urination

since 3 mts, menorrhagic cycles since 6 mts. M/H- Regular cycles 5-6d/30-35d O/H- Married for 9yrs, P3 L3 All FTND P/H- No h/o loss of weight or loss of appetite

 G/E- Moderately built and nourished, No pallor and No lymphadenopathy Other systems WNL Abd- Mass 14-16 wks size, medium consistency, smooth surface, regular margins and mobile. P/S- Cervix ballooned out. P/V-

USG

MANAGEMENT
Routine investigations done and posted for open myomectomy(Considering her age). Suspecting ureteric injuiry (as it is cervical fibroid), pre-op ureteric stents (double J) placed. Under SA, abd opened in layers. A friable mass occupying isthmic region and extending further down is seen.

 Friable tissue was sent for frozen section section examination suspecting malignancy. Frozen section showed, small round cells with prominent nucleoli, confirming malignant nature of the tissue. Plan of management changed to TAH with BSO.

 Bladder base separated from the mass with difficulty and further proceeded with TAH with BSO. Hemostasis secured and abd closed with drain in situ.

HPE-REPORT
Macroscopic features- Ut enlarged and showed multiple nodular, haemorrhagic raw areas on surface. Cut section showed multiple cystic to solid grey white lesions. Microscopic features- Small round to oval cells with hyperchromatic nuclei. Extensive areas of necrosis. Neoplasm extending to cervix downwards and extending up to serosal surface. Myometrium shows lymphovascular emboli.

 Mitotic figures 10/10 HPF Diagnosis: Undifferentiated malignant neoplasm, possibly small round cell tumour from uterus. Tubes and Ovaries free of tumour. Lymph nodes free of tumour.

Immunohistochemistry Report
Vimentin +ve S100 +ve Cytokeratin ve Desmin ve ER ve PR ve

SARCOMA
2-6 % of uterine malignancies. Mesodermal origin Dofferent from Endometrial Carcinoma with regard to diagnosis, clinical behavior, pattern of spread and management. Age of onset- perimenopausal 45-50 yrs.

 Symptoms- Rapid growth with vaginal bleeding, pressure effects, sometimes abd-pelvic mass. Classification A) Pure non-epithelial: 1) Homologous 2) Heterologous B) Mixed epithelial and non-epithelial tumours: 1) Malignant mixed mullerian 2) Adenosarcoma

MANAGEMENT
TAH with BSO with/ without Radiotherapy depending on stage.

 Prognosis- depends on extent of tumour.