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Indian Journal of Medical and Paediatric Oncology
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GRAND ROUND
Year : 2019  |  Volume : 40  |  Issue : 2  |  Page : 277-278  

A lady with hypogastric mass


1 Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
2 Department of Obstetrics and Gynaecology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
3 Department of Urology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
4 Department of Pathology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
5 Department of Nuclear Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
6 Department of Radiodiagnosis, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

Date of Web Publication17-Oct-2019

Correspondence Address:
Padmaj Kulkarni
Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmpo.ijmpo_170_19

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How to cite this article:
Kulkarni P, Gandhi S, Gokhale A, Shivde S, Kashyapi B, Purandare S, Nilegaonkar S, Desai S. A lady with hypogastric mass. Indian J Med Paediatr Oncol 2019;40:277-8

How to cite this URL:
Kulkarni P, Gandhi S, Gokhale A, Shivde S, Kashyapi B, Purandare S, Nilegaonkar S, Desai S. A lady with hypogastric mass. Indian J Med Paediatr Oncol [serial online] 2019 [cited 2019 Nov 18];40:277-8. Available from: http://www.ijmpo.org/text.asp?2019/40/2/277/269451

A 56-year-old woman presented with bleeding from a mass in the hypogastric region of 2 months' duration. Clinical evaluation revealed a round, polypoid, irregular, friable mass in the hypogastric region [Figure 1], which also affected the clitoris and the labia majora. The lesion bled on palpation.
Figure 1: Clinical photograph

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Vagina and the external cervical os were recognized, though the external urethral meatus could not be clearly visualized. The left ureteral opening was clearly seen, but the right ureteral opening could not be well identified. Bilateral inguinal lymph nodes were not palpable.

Contrast-enhanced computed tomography of the abdomen and pelvis demonstrated marked widening of pubic symphysis with a lesion of 6.7 cm × 6.1 cm × 4 cm involving the undersurface (anteroinferior) of the urinary bladder extending up to the introitus [Figure 2]. Anterior vaginal wall appeared thickened with the involvement of its lower third with loss of fat plane with the anterior cervical wall as well. Both the ureters were well opacified in the delayed images and appeared dilated and tortuous throughout the entire course with inferiorly located ureterovesical junctions. The excreted contrast leaked through the posteroinferior and anterior aspects of the bladder [Figure 3].
Figure 2: MRI

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Figure 3: Excretion of contrast

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Positron emission tomography demonstrated a 4.8 cm × 2.5 cm lesion with standard uptake value of 29.57 in the region of urinary bladder. Hydroureter was noted on either side in lower part with no distal metastases [Figure 4].
Figure 4: PET-CT

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Biopsy of the mass showed well-differentiated adenocarcinoma. The tumor cells showed positivity for CK-7, CK-20, and CDX-2 and were negative for GATA3 and p63 [Figure 5]. Routine laboratory investigations were within normal limits.
Figure 5: Histology H and E

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  1. What is the diagnosis?
  2. What is the primary treatment?
  3. What should be the adjuvant treatment?.


Answers

For answers to the above questions, please refer to page no. 316.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Answers

  1. Adenocarcinoma of extrophied bladder
  2. Surgical treatment: Anterior exenteration with ureterosigmoidostomy. Primary abdominal wall closure with bilateral local skin flap advancement.


  3. Histology showed well-differentiated adenocarcinoma (enteric type) involving the mucosa of bladder and underlying muscular layer focally. All margins were negative. TNM stage was pT2aN0M0.

  4. Adjuvant treatment: You may email your evidence-based considered opinion on editorijmpo@gmail.com. The most appropriate answer will be published in the next issue.



    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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