VAGINAL SARCOMA IN AN INFANT SEVEN

TEEN MONTHS OF AGE.

BY O. L. HOLMES, M.D., COVINGTON.

The case here reported was first seen on the 17th of June, 1903, having been referred to me for treatment by Dr. A. W. Shaw, of Monticello, Ga.

The following history was elicited from mother:

Parents healthy; child age seventeen months, female; has had no serious illness; in the preceding February had a fall, after which it was fretful; about three weeks after fall noticed that there was a slight pale reddish vaginal discharge, and child became very anemic, the discharge increased, and began to have a slight disagreeable odor; slight pain on micturition; bowels inclined to be constipated; about April noticed that there were small masses expelled from vagina after child strained at defecation; had been treated with vaginal douches and tonics with no improvement. The child presented an extreme anemic condition; temperature 101, pulse 130, and soft; was fretful and had difficulty on micturition, and bearing-down pains on defecation; a mass about size of a small orange presented itself above symphisis reaching near the umbilicus, soft and fluctuating; slight vaginal discharge, pinkish in color, and some odor; no vaginal examination made at time; was prepared for operation on the 22d of June; after anesthetized a digital examination of vagina attempted; the vagina was found filled with a soft, friable,

gelatinous, vascular mass, which curetted away with the finger, and about four to six ounces of a reddish gray material was removed, some odor; the infantile uterus could be felt, and did not seem to be involved, the tumor apparently springing from the anterior wall of vagina; after relieving this condition, about four ounces of urine. was passed involuntarily and the abdominal tumor disappeared; the vagina was irrigated with a one to eight thousand permanganate of potash solution was packed with iodoform gauze. The child rallied from anesthetic nicely.

The gauze was allowed to remain for three days, when it was removed, and was found to be saturated with a sero-bloody discharge.

The irrigations were ordered daily, and child placed on tonic treatment. It improved in every respect for about six weeks.

About August the first mother noticed that the discharge was returning, and was of a very foul odor, and difficulty of defecation and micturition returning.

It was returned for treatment on the sixteenth of August and a second operation was done, and about three ounces of the same character of material removed, only odor was more offensive.

A specimen of this was sent to Dr. Claude Smith, of Atlanta, for a report on it. He reported that it was a specimen of sarcoma of the round cell variety.

Child improved for a short period after second operation, but soon relapsed and was returned and operated on three different times between the first of September and December, when death resulted.

The growth returned rapidly after each operation; the temperature during the course of trouble was intermittent in character.

The child at time of death presented a general anarsar

cic and pyemic condition, death resulting from uremia and septicemia.

No autopsy allowed.

In connection with this case, I wish to present the reports and discussions of similar cases on record. Most authorities agree that it is of rare occurrence.

Dr. Wrede, in 1903, reported a case in a child 21 months of age. It had shown at first symptoms of fever and anorexia, later a small cauliflower growth was found protruding from vagina. It was removed by ligation, but recurred in two weeks. Repeated operation, tumor continued to grow, and finally became associated with cystitis, and continued fever before death, which occurred about twelve months after first seen.

It was found to be a round and spindle cell sarcoma. C. H. Frick, in 1888, reports two cases. First, age seven months, presented a tumor, pale, smooth, size of walnut, no symptoms of pain, hemorrhage, or discharge. Operation, removal of tumor from right anterior vaginal wall; rapid recurrence and death.

Was found to be a round spindle cell sarcoma.

Case second, age two years, tumor size of walnut, originating from posterior vaginal wall near vaginal entrance; operation, recurrence; second operation, tumor same character as first, that is, cylindrical, round and spindle-shaped cell.

Child recovered, and was well three years after second operation.

Piechaud and Guyot, in 1901, reported a case of primary sarcoma in an infant two years of age. Tumor protruded from vagina, and gave rise to serious hemorrhage. Diagnosis of primary sarcoma of vagina. Inoperable on account of size. Autopsy revealed a general

ized, suppurating peritonitis to have been direct cause of death.

Tumor originated from posterior vaginal wall, anterior wall was congested without ulceration. Uterus was not connected with tumor.

Dr. Schuchardt, in 1888, cites several cases, two under his care.

First, age seven months, tumor, smooth, pink, hazlenut size, at vulva, grew rapidly, difficulty on micturition and defecation. Tumor removed, composed of button-like polypi like bunch of grapes, microscopical findings round and spindle cell sarcoma. Child died five months after operation from recurrence.

Second case, age two years, six months, had pertussis lasting six to eight weeks. Tumor first noticed at that time, some pain and hemorrhage, tumor removed; microscope showed round and spindle cell sarcoma.

Tumor recurred seven months later and was removed again, tumor same as first; no recurrence when last heard from.

M. Sanger, in 1880, reports a case in a child three years of age.

Two pedunculated polypus growths projected from vulva size of small grape, soft consistency and pinkish color. Tumor apparently attached to left lateral wall of vagina. It was suppurating. Operation, removal of portions of tumor. Radical operation not advisable; tumor was a typical round cell sarcoma. Child returned in two months with a recurrence; result, death.

Autopsy showed general anasarca and anemia. Acites, accompanied by suppurative peritonitis. Large sarcoma of anterior vaginal wall. Isolated polypi of posterior wall perforating abdominal cavity. Dilation of bladder and

ureters.

A. Kolisko reports three cases in 1889. First, age eighteen months, died two weeks after admittance to hospital from polypus, vaginal sarcoma.

Autopsy showed anemia of internal organs, nodular tumor of vestibule, infiltrating vagina, urethra, base of bladder and cervix uteri, followed by cystitis, pyelitis and pyelonephritis and pyometra, anemia and sepsis; microscope showed myo-fibro sarcoma.

Second case, age twelve months, tumor protruded from left of vulva, presented a number of large and small polypi. Repeated operation with rapid recurrence after each, finally death about six months after first noticed; microscope showed round and spindle cell sarcoma. Neoplasm originated in left vaginal wall, infiltrating rectum and vagina. Retention of secretion due to polypi caused pyometritis and suppurative peritonitis, causing death.

Case three, age eighteen months, admitted to Bilbroth's Clinic in 1875. Tumor protruding from vulva about one month before admittance. No symptoms for two weeks. Vagina long. Removal. Improved, but vagina became filled with vegetation after operation; result death.

Autopsy, neoplasm originating in anterior vaginal wall, tumor grew to size of walnut in six weeks; microscope showed myo-fibro sarcoma.

Kolisko also gives abstracts of eleven cases of sarcoma in children and concludes his paper, giving his opinion that only early and radical extirpation of primary tumor justifies one to hope for a successful issue.

Dr. A. Power, in 1895-6, reports a case, age two years four months, admitted to hospital for retention of urine caused by tense swelling of vagina, said to date from measles fourteen months previous. Five months before admittance noticed small polypi projecting from vulva; died with symptoms of uremia.