RCOG World Congress 2023

TITLE: Unusual Case of Menorrhagia

Objective

-Menstrual disorders are the second most common gynaecological condition to be referred to hospital.

-This case explores a rare cause of heavy menstrual bleeding.

Background

•Around 30% of women report having heavy periods1.

•The perception of what constitutes ‘heavy’ bleeding is subjective, where 1/20 women between age 30-49 seek further advice1.

•Menstrual disorders are the second most common gynaecological condition to be referred to hospital.

•Of those who complain of excessive bleeding, 40-60% have no underlying pathology, and thus are treated as dysfunctional uterine bleeding2.

•Suspected underlying cancer usually presents after the age of 50, classically with Post Menopausal Bleeding.

Patient timeline of events

•31 year old nulliparous presents to outpatient gynaecology with painful heavy periods.

•Examination and Pelvic USS unremarkable, started on Yasmin pill and discharged after 4 month follow up.

•A year later presents to A&E with flooding, found to have a large necrotic polyp protruding from the cervix.

•Biopsy was taken and histology confirmed EmbryonalRhabdomyosarcoma (see images).

•Regional MDT sarcoma treatment included a combination of chemotherapy and brachytherapy.

•Remained disease free at five year follow up .

Discussion

•Embryonal rhabdomyosarcoma is a rare malignant skeletal muscle tumour of the soft tissue.

•There are 3 types of rhabdomyosarcoma; Embryonal, Alveolar and pleomorphic3.

•The most common type that presents in the cervix is Embryonal Rhabdomyosarcoma (ERMS).

•Embryonal RMS has a five-year overall survival of 82% compared with 66% for non-embryonal variants.

•Favourable prognostic parameters were single polyp, embryonal histologic subtype, and localized disease without deep myometrium invasion.

•Reproductive function may be able to be preserved; however, for women presenting with unfavourable prognostic parameters and where there are no fertility preservation concerns, radical surgery and adjuvant chemotherapy seems to be the most appropriate treatment4.

Conclusion

•Adult Embryonal rhabdomyosarcoma is best treated with a Multidisciplinary approach with multimodality treatment.

RCOG World Congress 2023

Gestational Choriocarcinoma arising from an Ovarian Ectopic

Poster Presenter

Authors

Affiliations

Part of Topic

Audio