text:  Her temperature is 97.9   blood pressure 160  80   heart rate 92   her HEENT examination reveals anicteric sclerae and her left eye has slightly relaxed inferoorbital wall . Her chest is clear to auscultation . Her heart has regular rate and rhythm with I    VI systolic ejection murmur at the base . Abdomen is obese   soft   non-tender   and without palpable masses . Extremities two plus pulses bilaterally and nonpitting edema up to the knees in both legs . Neurologic examination  is unremarkable . LABORATORY DATA  sodium 142   potassium 3.3   chloride 98   bicarbonate 34   BUN and creatinine 14  0.9 . Her alkaline phosphatase is 77   white blood count 12.5   hematocrit 42.6   platelet count 268 . IN SUMMARY  This is a patient with recurrence of a mixed mesodermal cancer at the vaginal apex who presents for local excision .