Manjari Gupta

Abstract

Introduction: Nodular malignant hidradenoma (NH) of vulva is a rare entity. It is a malignant, aggressive tumor of the eccrine glands that was first reported in literature as a clear cell eccrine carcinoma in 1954. It is a rare tumor with predilection for the head face and extremities. It usually present in sixth decade of life with equal male/female distribution but cases have also been reported in children and neonates. Here we present a case of malignant nodular hidradenoma vulva in a 20yr pregnant woman. Case Presentation: A 20yrs old primi patient at 38weeks pregnancy presented to our outpatient department with a painless vulval swelling since 3 months which had increased rapidly in size. On examination the swelling was arising from upper one third of right labia minora. The mass was 4 x 4 cm in size and was displacing the urethral meatus towards left and involving the vagina upto the fornices. The patient had history of excision of similar vulvar swelling 7 months back and the histopathology was suggestive of hidradenoma vulva. Patient delivered vaginally after 2 days. She was thoroughly investigated.CT scan lower abdomen and pelvis and chest x-ray revealed that it was a locally invasive tumor with distant metastasis. Patient was given neoadjuvant chemotherapy for 3 cycles after which surgical excision of the residual disease with bilateral inguinal lymphadenectomy done post operatively 3 more cycles of chemotherapy given. Patient was kept in regular follow up. Conclusion: Malignant hidradenoma of vulva is a locally aggressive tumor with rapid progression, poor prognosis and high recurrence. Early diagnosis and excision with adjuvant chemotherapy is imperative. Keywords:  Malignant, Hidradenoma, Vulva, Metastasis.

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Abstract

Introduction: Partial molar pregnancy in non-communicating rudimentary horn of unicornuate uterus is very rare. It often has catastrophic results. It may be missed as an early diagnosis unless it results in rupture of the horn in the late 1st or early 2nd trimester. Pre rerupture diagnosis of rudimentary horn pregnancy with USG is technically difficult with a poor sensitivity. Case Presentation: We present a case of unruptured non-communicating rudimentary horn pregnancy at 7 weeks with live fetus presenting in our emergency department with pain in abdomen. Laparotomy was carried out and excision of rudimentary horn was done. However, the histopathological reports were more surprising suggesting to be a partial hydatidi form molar pregnancy in rudimentary horn. Beta-hCG report w as 50,000 miu/ml. Serial Beta-hCG was done weekly till its values reached well within normal limits after 10 weeks. Conclusion: Development of partial molar pregnancy in a rudimentary horn is a very rare phenomenon. High degree of clinical suspicion is required when ultrasound reports are inconclusive regarding intrauterine pregnancy. Further close follow up of patient is required in future pregnancies to avoid recurrence of molar pregnancy. Keywords: Partial Hydatiform mole, Rudimentary horn, Unicornuate.

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