AN INTERESTING CASE REPORT
Dr Sujoy A Das MS, DNB, McH
Paediatric and Neonatal surgeon.
An 11-month-old girl was brought to our hospital with bleeding per vagina and blood staining of her undergarments. She gave a history of repeatedly putting her finger in her vagina and her mother attributed this to be the cause of bleeding. On inspection only a few blood clots could be seen coming from the vagina.
A working diagnosis of a polyp or a foreign body in the vagina was made. After doing a routine hematological workup the child was posted for Vaginoscopy and cystoscopy.
Cystoscopy did not reveal any abnormality but vaginoscopy showed a vascular mass in the post fornix from which a biopsy was taken. The biopsy revealed the mass to be a Yolk sac tumor arising from the Vagina.
The Alfa feto proteins level was raised markedly. Ultrasound revealed the mass extending into the pelvis. However there was no metastasis to the Liver or Lungs. A diagnostic Laparoscopy done revealed mass protruding into the pelvis. A laparotomy was done and pan Hysterectomy with vaginectomy was done. The child is now receiving chemotherapy at Tata Memorial Hospital.
Yolk sac tumors or endodermal sinus tumors are very rare tumors, and very uncommonly come from the vagina. These probably arise from the mesonephric remnants of the divertucla of the yolk sac. endoderm. They are highly malignant tumors with a poor prognosis. The treatment of this rare pediatric malignancy is usually multimode with Surgery followed by chemotherapy and radiotherapy. The VAC regimen is most commonly used .( Vincristine , Adriamycin, Cyclophosphamide). Monitoring the alpha-fetoprotein levels follows the recurrence of these tumors.
The child has received three cycles and is awaiting completion of chemotherapy following which radiotherapy will be started.
REFERENCES
1) Neonatal tumors, Prem Puri, Springer.
2) Diagnosis and treatment of the endodermal sinus tumors of the vagina.
Zhonghua Fu Chan Ke Zha Zi 1999, Feb. 34.
3) Clinical experience with conservative surgery for vaginal endodermal sinus tumours.J Paed Surgery 1996, Feb 31(2) 219 –22.
