Sarcoma botryoides a management dilemma: A review of two cases

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. ABSTRACT Introduction: Sarcoma botryoides is a rare and rapidly growing tumor affecting primarily the female genital tract of children. It presents as bleeding per vaginum or as a polypoid fleshy mass protruding through the vagina. Treatment is surgery combined with multidrug chemotherapy. In developing environment, one has to contend with late presentation, availability and affordability of cytotoxics and the surgical options available at advanced stage, their acceptability, their management postoperative and their impact on quality of life. Case Series: The first case was a four-year-old child who presented with a rapidly growing mass protruding per vaginum, intermittent vaginal bleeding and difficulty in passing stool and urine. She had examination under anesthesia and biopsy. Histology confirmed sarcoma botryoides. Her parents opted for multidrug chemotherapy and was treated with a combination of cylophosphamide, vincritine and doxorubicin. She had six courses of the drugs with remarkable improvement in symptoms and the tumor regressed almost completely. Patient was subsequently lost to follow-up. The second case was a six-month-old child who presented with vaginal bleeding, vaginal growth and abdominal swelling. Histology confirmed sarcoma botryoides and the parents were counselled on management options which they declined and took the child home. The child was brought back with obstructive uropathy and septicemia. She had suprapubic cystostomy to relieve the obstruction. However, her condition deteriorated and she died a week after admission. Conclusion: Sarcoma botryoides is a rapidly growing malignancy, early presentation and prompt and aggressive surgery combine with multidrug chemotherapy may be the answer if outcome is to be improved. To ensure this in low resource countries free health care for children and all individuals with malignancies and chronic debilitating diseases should be provided. In addition education and poverty alleviation will further save the situation.