Gynecology World Conference 2026

Abstract

Patient A, born in 2011 (age 13), presented with complaints of bloody, foul-smelling vaginal discharge for the past three months. Past medical history: Menstruation since age 12, irregular, lasting 7 days, moderate, and painful.

On examination: the patient is of normosthenic build. Rectal examination reveals a dense, irregularly shaped mass up to 3-4 cm in diameter, painless on examination, in the projection of the cervix. Insertion of a speculum into the vagina reveals multiple, irregularly shaped, cauliflower-like masses that bleed vigorously upon contact. The base of the masses is not visible. A single-digit examination reveals the walls of the masses to be free of the vaginal walls, and the base of the masses is not detectable. Discharge is moderate and bloody. The ovaries are palpable, with the right ovary enlarged to 6 cm and tender when moved.

Laboratory parameters were within normal limits.

According to pelvic ultrasound, the cervix was dilated to 12-13 mm, filled with heterogeneous contents. The right ovary was enlarged due to a heterogeneous mass (solid component with a limited fluid component), measuring up to 46-48 mm in diameter. Reliable blood flow is detected in the projection of this mass.

Chest CT revealed a pericardial fluid accumulation of up to 9.5 mm, with moderate quantitative axillary lymphadenopathy. Echocardiography revealed a small pericardial effusion.

Colonoscopy revealed epithelial formation of the rectum (endoscopic removal).

Primary diagnosis: Abnormal uterine bleeding during puberty.

Concomitant diagnosis: Mild anemia. Functional cyst of the right ovary. Differential diagnosis includes a right ovarian mass. Cervical mass, Vaginal mass.

According to the histological examination data: Macroscopically, tissue fragments of irregular shape, soft elastic consistency, total size 9x6x3.5 cm, solid structure on section, with a small number of cysts up to 1 cm in diameter, filled with transparent content. When staining with HE, a mixed tumor with predominance of the mesenchymal stromal component with small inclusions of rounded and elongated rhabdoid cells was microscopically revealed. High mitotic activity in the stromal component. When using antibodies S100, WT1, CD34, PR, MSA (HUC1-1), Ki67, ER, SMA, Vimentin, CDS6, Desmin, Myogenin, p53, PanCK (CK AE1/AE3): Tumor cells (in the stromal component) are diffusely positivity to Vimontin; focally to ER, PR, WT-1, SMA, CD56. Reaction with antibodies to Myogenin, Desmin, and MSA is found in the rhabdoid component. Isolated reactions with the p53 antibody are also observed in cells. Reaction with the CD34 antibody is found in the vascular endothelium, and PanCK is found in the glandular epithelium. A negative reaction was detected with the S100 antibody. The proliferative index, based on the Ki-67 expression level, ranges from 3 to 80% in hot spots. This corresponds to adenocarcinoma with stromal and rhabdoid malignant components.

Conclusion: This clinical case attracted our attention due to the detection of adenocarcinoma at an early age (13 years). Successful treatment of this disease directly depends on a comprehensive examination and timely and adequate treatment.