Report of Two Cases THEODORE
NEW YORK, N.Y.
HE term ‘(sarcoma botryoides ” is applied to mesodermal mixed tumors of the lower genitourinary tract. The word botryoid in Greek means “like a bunch of grapes, ” and refers to the peculiar characteristics of this type of neoplasm which looks like grapelike masses. In males it originates in the bladder, urethra, and prostate; in females in the cervix, vaginal vault, and occasionally in the bladder. It is a comparatively rare tumor. Among 26,114 gynecologic admissions to the Charity Hospital, New Orleans, only 21 cases of botryoides sarcoma were recorded according to Sternberg and associates.5 Dwyerl reported only one case among 4,000 gynecologic admissions. It occurs predominantly in children. McFarland3 collected reports of 74 cases, all of them occurring in patients less than 22 years old. Forty-two of these cases were in children of 2 years of age or younger. The tumor, which actually arises in the Miillerian duct, is relatively rare in the male. This may be explained by the fact that the tube disappears at an early developmental stage in boys. The botryoides sarcoma progresses rapidly, invading the adjacent viscera and the bladder. Its usual course is repeated recurrence and death from obstruction of the urinary passage. No authentic cures were confirmed by McFarland3 in his collected cases. Isolated casesreported since his review were all fatal.ls 2, F The recent paper by Ober and Edgcomb,4 based on a search of the world literature, revealed only one case in which a 5 year survival following operation had been achieved. In another case, reported by Frick,” in which the patient was living and well 10 years after two operative removals of the tumor, the bot,ryoid tumor was situated upon the posterior vaginal wall. CASE 1.-F. T., a 46.year-old unmarried white woman, whose menstrual history had been normal until February, 1949, began to have intermenstrual bleeding accompanied by a yellowish discharge. She had been seen by her family physician, who prescribed local therapy. Since this did not control the symptoms, the patient was referred to us.
On her first visit in April, 1949, she had lost no weight and had no other symptoms On examination, a large polypoid mass than the intermenstrual bleeding and discharge. involving the vault of the vagina and the cervix was found. The tumor measured approxThere did not appear to be any imately 8 cm. in diameter, and bled readily upon palpation. Roentgenogram of the chest was negaintra-abdominal extension or fixation of the tumor. tive. On biopsy, the tumor was noted to be a mesodermal mixed tumor of the cervix. 1172
The patient was admitted to the hospital and an abdominal partial vagineetomy were performed. Severe bleeding was encountered, The tumor mass measured approximately of 1,500 C.C. of blood. diameter and involved the vault of the vagina as well as the cervix
total hysterectomy and requiring replacement 10 cm. in its greatest (Fig. 1).
The patient’s postoperative course was uneventful except for jaundice, due to hemolysis, the patient has remained well without any evidence which cleared rapidly. Since operation, of recurrence. Hhe was last seen in December, 1957, at which time she was in good health. Review
” ). Comment.-111 ljy an abdominal
case of sarcoma hysterectomy and
botryoides, a survival partial vaginectorny.
size of tumor
CASE 2.-This patient was a white girl, 18 years old. At the age of 5 years, she had fallen out of a second-story window and fractured the maudible and skull. She had no trouble from this or any other illness until she developed persistent vaginal bleeding about 3 weeks before she sought medical attention. On examination this was found to be due t,o x t,umor protruding from the cervical OS. Biopsy showed it to be a sarcoma botryoides. Examination a grapelike tumor It did not appear with
disclosed protruding to invade
a young girl in excellent general from the cervix and extending the bladder or the rectum.
The patient was admitted a partial node dissection;
in January the ovaries
of 1956 and were preserved.
health: the only findings mere into the vault of the vagina.
a panhysterectomy The patient
carried out until May,
:\,>I. J. Obst. 8, Gwcc. December, 1958
1956, when she was examined and a large abdominal mass was disclosed. Laparotomy reveaIed sarcomatosis involving the entire abdomen. The major portion of the tumor was scooped out. This measured approximately 30 by 22 by 7 cm. in its greatest dimensions. The omentum was removed and the peritoneal cavity lavaged and the wound closed without drainage. The patient was then given x-ray therapy to each of four abdominal quadrants, receiving 2,100 r in each, with the use of 250 kv. at 30 Ma., with 1% mm. of copper filter at 70 em. target-skin distance. Patient was given Oreton intramuscularly every week. In July, a paracentesis was done which removed 3,200 C.C. of bloody fluid.
On Aug. 16, 1956, the patient film remained clear throughout.
Comment.-In to prevent
this case of a fast-progressing the fatal outcome of the disease.
Summary Two cases of sarcoma botryoides are reported. In one case of sarcoma botryoides, in a 26-year-old woman, an abdominal. total hysterectomy and partial vaginectomy resulted in an 8 year survival of the patient.
In the second case, in an 18-year-old girl, a panhysterectomy vent abdominal sarcomatosis and fatal outcome of the disease. References 1. 2. 3. 4. 5. 6. i.
Dwyar, W. A.: AM. J. OBST. & GYNEC. 48: 119, 1944. McCormack, L. J., and Higgins, C. G.: Cleveland Clin. Quart. 22: 16, 1955. McFarland, J.: Surg., Gynec. & Obst. 61: 42, 1935. Ober, W. B., and Edgcomb, J. H.: Cancer 7: 75, 1954. Sternberg, W. H., Clark, W. H., and Smith, R. C.: Cancer 7: 704, 1954. Tracy, S. E.: AM. J. OBST. & GYNEC. 19: 279,193O. S. Clin. North America 27: 1240, 1947. Ulfelder, H., and Quan, S. H.:
failed to pre-