A CASE OF VULVAL

CARCINOMA
Particulars of the patient:
Name: Mrs. Khairun Nesa
Age:66yrs
Religion: Islam
Occupation: Housewife
Address: Chandpur
Ward no: Gynae Unit 2
Bed no:10
Reg no:2099/13
Date of admission:22.08.10
Date of examination:23.08.10
Chief complaints:
1.A growth in vulva for last 6 months.
2.Vulval itching for same duration.
3.Burning sensation during micturition for 5 months.
H/O present illness:

According to the patient statement, she was

reasonably well 6 months back. Then she suddenly
noticed a growth in vulva which was rapidly growing
and became fungating for the last 5 months. She also
stated that there was offensive discharge from the site
but the lesion was painless. She also gave history of
vulval itching and mentioned low grade fever for last
5 months. She also mentioned difficulty and burning
sensation during micturition for same duration but no
difficulty during defecation. There was history of,
anorexia, malaise and wt loss. She did not give any
history of P/V/B. With these complaints she got
herself admitted into SSMC&MH for better
management and treatment
 H/O past illness:
No significant H/O past illness.
Family history:
No family H/O DM, HTN or asthma.
Personal history:
Non alcoholic, non diabetic. On regular diet with good
appetite. sleep-normal.
Socio-economic history: Patient belongs to low socio-
economic group.
Drug history: No significant drug history. Not immunized
with TT.
Mestrual history:
Age of menarchy-13yrs
H/O menopause 12yrs back with previously normal mestrual
cycle. Contraceptive history-Never practiced.
Obstetric history:
Married for 40yrs.
Para-7+0
ALC-16yrs.
General Examination:

Appearance: Ill looking

Body build : Avg.
Co-operation :Co-operative
Anaemia – Absent
Jaundice - Absent
Cyanosis: Absent
Lymph node: Left inguinal LN pulpable
Pulse: 88/min
BP: 120/80
Respiration: 18/min
Temp: 98.4° F
Dehydration: Absent
 P/A/E:
Inspection:
Shape: scapoid
Umbilicus: Inverted and centrally placed
No scar mark, No pigmentation, No engorged vein, Loss of
pubic hair in affected site. Hernial orifices intact.
Palpation: No mass found. Tenderness- absent. Fluid thrill-
negative.
Percussion: Tympanic
Auscultation: Bowel sound present.
On local examination:
Site: A fungating growth occupying lt. side of vulva, labium
minus, majus and part of perianal region but not upto the
clitoris.
Size and Shape: Single in no(7*4*2.5)cm in size. Irregular in
shape.
Floor& base: Sloughing base.
Margin: Raised everted edges
Surrounding area: Surrounding skin is intact. Discharge-
purulent.
 On palpation: slight tenderness present. Edges raised,
everted&hard& irregular. Sloughing base with
surrounding induration. Floor is fixed with underlying
structure. Bleeds on touch.
Lymph node :Lt inguinal LN palpable. 2*2 Cm in size,
stony hard in consistency, fixed to neighboring
structure.
On exam of pelvic organ: Cervix, vagina ,urethra&
rectum-intact

CVS:1st &2nd heart sound are audible. No added sound.

Resp sys: Both lung field are clear with vesicular breath
sound with no added sound.
Genitourinary sys: Both kidneys –not palpable.
Nervous sys: No abnormality was detected.
Salient feature:

Mrs. Khairunnesa 66yrs old hailing from Chandpur admitted into

SSMC&MH under GU-2 on22-8-10 with the complaints of a
growth in vulva for last 6 months which became fungating for last
5 months, vulval itching and burning sensation during micturition
for same duration. She had no H/O difficulty in defecation. O/G/E
she was not anemic, jaundice & oedema absent ,temp-98.4’f
&pulse-88/min,BP-120/80mm hg. On P/A/E, normal per
abdominal findings. On local examination, a fungating growth
occupying lt. side of vulva, labium majus labium minus &part of
perianal region which is7*4*2’5cmin size, irregular in shape,
sloughing base which bleeds on touch with presence of mild
tenderness. Edge is raised, everted , hard and irregular. Lt inguinal
LN are palpable, 2*2cm in size, stony hard in consistency & fixed
with surrounding structure.

Provisional Diagnosis: Vulval Ca( Stage-ІІІ)

D/D:
1. Condylomata acuminate
2. Syphilitic ulcer
3. Soft sore
4. Lymphogralunoma venerium
5. Tubercular ulcer
Investigations:
CBC-Hb%, TC, DC ESR
Urine R/M/E
HBsAg,VDRL
S.Creatinine
ECG
X-Ray
RBS
Bl. Grouping
USG of lower abdomen
Histopathological exam(Biopsy from lesion)
Confirmatory Diagnosis: Vulva Ca (Stage-ІІІ)
Treatment: Conservative treatment given
Further plan of treatment: Radiotherapy.
THANKS TO ALL