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Vaginal cancer occurring in a woman with longstanding untreated total uterine prolapse
IUGA Academy. Temtanakitpaisan A. Jun 30, 2018; 212814
Topic: Pelvic Organ Prolapse
Amornrat Temtanakitpaisan
Amornrat Temtanakitpaisan

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Vaginal cancer occurring in a woman with longstanding untreated total uterine prolapse

Temtanakitpaisan, A1; Temtanakitpaisan, T1; Huang , K2

1: Faculty of Medicine, Khon Kaen University; 2: Department of obstetrics and gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Introduction: Vaginal malignancy is a rare condition, representing less than 2% of all gynecological cancers. Squamous cell carcinoma (SCC) accounts for ninety percent of vaginal cancers and frequently occurs in the proximal third of the vagina, notably at the posterior vaginal wall. The incidence of vaginal cancer is usually seen in postmenopausal or elderly women from 60-80 years of age. Theoretically, the key risk factors for vaginal cancer are the same as those for cervical cancer. Human papilloma virus infection is the most common cause of cervical cancer, as well as vaginal cancer. We report a rare case of primary invasive carcinoma of the vagina associated with a total uterovaginal prolapse.

Case Report: A 94-year-old postmenopausal woman with underlying diabetes mellitus who had been bedridden and presented with an irregular exophytic mass at the vagina for ten years. She also had the difficulty urinating and untreated longstanding uterovaginal prolapse. She had no history of cervical intraepithelial lesions, and her HPV status was unknown. Per vaginal examination revealed total uterovaginal prolapse with an exophytic mass 10 X 8 cm in size at the lower two-thirds of the posterior vaginal wall (Figure). The cervix looked grossly normal with one centimeter of space between the vaginal tumor and the cervix. No evidence of local spread was detected. The histopathological result from vaginal biopsy showed squamous cell carcinoma of the vagina. A metastatic workup revealed evidence of metastasis to the left high external and internal iliac lymph nodes. Stage III primary carcinoma of the vagina with Stage IV uterovaginal prolapse was diagnosed. Due to the patient’s frail, elderly, and bedridden status, she was given palliative radiotherapy as a treatment. The patient passed away after the fifth course of radiotherapy.

Discussion: Primary malignant vaginal cancers are rare and account for only 1–2% of all gynecological cancers. The combination of vaginal malignancy and uterovaginal prolapse is relatively rare, as is irreducible prolapse. Ulcerative vaginal carcinoma lesions are usually present in prolapse patients. In our case, the diabetic patient’s HPV status was unknown and the cervix appeared to be grossly normal. Punch biopsy of the lesions or colposcopic examination can be used to confirm histological diagnosis before the operation in prolapse patients in whom an abnormal vaginal mass is present in order to exclude underlying malignancy. There is still controversy regarding the proper management of this kind of malignancy due to the rarity of the disease. Surgery is suitable only in the early stages of the disease when there is no evidence of metastasis, whereas radiotherapy is preferable in advanced cases. In our case, the patient received palliative radiotherapy due to the advanced stage of the disease and her medically ill status.

Conclusions: Vaginal cancer occurring in uterovaginal prolapse patients were exceedingly rare. The incidence of vaginal cancer is commonly seen in elderly women. The management of vaginal cancer should adhere to the same guidelines, regardless of uterovaginal prolapse and its complications.


References:

  1. Journal of menopausal medicine. 2013
  2. Journal of medical case reports. 2011

Disclosure:

Work supported by industry: no.

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