An interesting case. This patient a female with a uterine mass - probably a large subserosal fibroid with degenerative changes - Ultrasound scan reporting one year back .Pt is 85 years old .Considering her age gynaecologists refused to operate telling that it is an advanced malignancy. Now after 1 year - Patient is having bleeding P/V - moderate to severe to the extent that Hb has come down to 4 gm . On home visit I examined the patient, there was a protruding fungating mass from vagina with secondary haemorrhage. A CECT abdomen was advised to look for present status. It revealed a Bosnaci Type 3- 4 right renal cyst , a large subserosal fibroid and a vulval malignant mass ? with bilateral enlarged inguinal lymph nodes . Now management advice . One year back can patient would have been operated? USG report is 1 year back and CECT abdomen is done today on 11 th March

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I think ,it is vulval malignancy in advanced stage . Don't give important to subserous fibroid, whether you have removed uterus along with fibroid one yr.back or you can remove now . Previous Gynaecologist has given good justification .

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Squamous cell carcinoma of vulva wth degenerative subserosal uterine fibroid.inguinal lymphadenopathy. In such case we think for redial hysterectomy wth chemo nd radiation but age is difficult factor.think to maneg conservatively.

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Most likely squmous cell carcinoma of uterus.only chemotherpy and Radiotherpy in the form of pulse therpy is the only Answer.TMN stage 3rd.

Why the primary is being cosidered in uterus and not in the vulval region.....sir
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Likely Squamous cell carcinoma of vulva. Subserosal fibroid has a old history that's why showing degenerative changes. Patient is a candidate for Curative Radiotherapy for Squamous cell carcinoma of vulva.

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Likely Squamous cell carcinoma of uterus. TMN stage 3.Chemotherapy and Radiotherapy in the form of pulse therapy is the only answer.

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Its a case of squamous cell carcinoma.chemotherapy will be helpful.

It is a case of squamous cell carcinoma of uterus Tatal Hysterectomy, and BIOPSY needed after report manage it

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Read above replies, just to add to some recommendations.. Squamous Cell Carcinoma of 'uterus' would be an improper terminology..it can be either cervix or endometrium..both unlikely in this patient..Vulva definitely looks malignant..so a vulval biopsy along with FNAC inguinal node(largest) will establish diagnosis..considering her age, Radiotherapy and Chemo is the answer especially if nodal metastasis present

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It's a good case to learn. Considering her age, operation as well as chemotherapy is risky though..

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