Introduction/Background*We present a rare case of high-grade poorly differentiated sarcoma. Due to the advanced nature of the disease this presented significant challenges regarding surgical management.

Methodology A 67-year-old lady with previous caecal cancer presented with significant procidentia descending 4-5cm below the introitus, which was ulcerated and friable. The patient was diagnosed with Covid-19 infection prior to surgery resulting in delayed management and need for prolonged catheterisation due to tumour related urinary retention. Type 3 radical hysterectomy was performed after we devascularized the uterus by division of the uterine artery at origin- the uterus was completely inverted pulling the round ligament, ureters and iliac vessels. Given the fact that it was not clarified whether it is cervical or uterine malignancy and following the LACC trial, we completed all steps via laparoscopy and colpotomy was performed via a 10cm transverse suprabupic incision to avoid spillage.

Result(s)*Histopathology indicated high-grade poorly differentiated sarcoma of unknown origin extending from beyond the cervix within the vaginal vault inwards, enveloping the cervical and lower uterine walls. The endometrium was inactive, the myometrium did not contain any leiomyomatous or stromal lesion and both adnexa were normal. Catheter was removed 4 months after her presentation.

Conclusion*The cornerstone of the optimal management of such rare and complicated cases is a combination of continuous multidisciplinary team consensus, precise surgical management and close surveillance of the patient.