Presentation
The patient presents with a known vulval mass, abdominal distention and weight loss.
Patient Data
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There is an unusual X-ray finding of a large, irregular, lobulated vulval and perineal mass.
The bony pelvis is normal.
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The supine chest X-ray demonstrates probable bi-basal pulmonary nodules (left retrocardiac), a possible right upper lobe nodule and a right paratracheal nodule or metastatic lymph adenopathy.
The lung fields are otherwise unremarkable.
There are no bony metastases
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There are generalized and significant simple ascites. There is hepatomegaly with diffuse hepatic metastases. The renal tracts remain non-obstructed. There is no obvious intra-abdominal or intra-pelvic lymphadenopathy.
Case Discussion
A case of a suspected stage IVB primary vulval carcinoma with an unusual plain film identification of a locally aggressive and advanced vulval mass lesion.
The positive ultrasound and suspicious chest X-ray findings suggest distant metastases.
The presentation is unusual in a young patient and at work up the patient is found to be HIV positive.
The patient is awaiting staging imaging (CT/MRI).