Novel Insights from Clinical Practice Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
Received: August 19, 2013 Accepted after revision: November 26, 2013 Published online: January 23, 2014
Uterine Prolapse Complicated by Vaginal Cancer: A Case Report and Literature Review Yueling Wang a Qiling Li a Huiping Du c Shulan Lv a Huiting Liu b a c
Department of Obstetrics and Gynecology, at b First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China; Fiscal Research Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Ga., USA
Established Facts • For squamous cell cancers of vaginal cancer, radiation therapy is used for most stage I vaginal cancers. Removing part or the entire vagina is an option for some cancers.
Novel Insights • Surgery and radiotherapy can be effectively combined in patients with vaginal carcinoma and complete genital prolapse for reducing morbidity and improving quality of life. • We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration to exclude vaginal cancer.
Key Words Uterine prolapse · Vaginal cancer · Diagnosis · Treatment
Abstract Primary vaginal cancer is not common, representing 1–2% of all female genital malignancies. We present a case of a third-degree uterine prolapse complicated by an isolated primary vaginal cancer and its surgical treatment. The cervix was clinically normal, but on the nearby prolapsed vaginal wall, a large exogenous hard lesion had developed. A biopsy of the lesion revealed a squamous carcinoma. The patient
© 2014 S. Karger AG, Basel 0378–7346/14/0772–0141$39.50/0 E-Mail [email protected] www.karger.com/goi
was asymptomatic and had no recurrence during the last 4 years of follow-up after surgical treatment with radiotherapy. The surgical treatment with or without radiotherapy is the optimum treatment for uterine prolapse with early-stage vaginal squamous cell carcinoma, although the majority of vaginal malignancies are treated with radiotherapy. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration. © 2014 S. Karger AG, Basel
Yueling Wang and Qiling Li contributed equally to this work.
Qiling Li, MD, PhD First Affiliated Hospital, Xi’an Jiaotong University 277 Yanta West Road Xi’an, Shaanxi 710061 (China) E-Mail liqilinglady @ 163.com
Introduction
Most vaginal malignancies are metastatic, arising most commonly from other pelvic organs, such as the ovaries, endometrium and cervix. Primary vaginal cancer is not common, representing 1–2% of all genital malignancies in women [1]. Reviewing the literature on uterine prolapse reported before 1970, we found that most cases of uterine prolapse are located in economically undeveloped areas, where grand multiparity is more common [2]. We present this rare case of severe uterine prolapse complicated by primary vaginal cancer.
Case Report A 61-year-old Chinese woman, gravida 5, para 4, presented with a 30-year history of a painless vaginal mass without a history of cervical intraepithelial carcinoma. The HPV infection status was not known. She was not using a pessary. The vagina was enlarged, and the patient had suffered difficulty urinating during the preceding 10 years. Biopsy of the vaginal ulcer, performed at another hospital, revealed squamous cell carcinoma of the vagina. Local examination revealed a third-degree uterovaginal prolapse. A 7 × 5 cm ulcer was present on the upper third of the right lateral vaginal wall, with marked induration of the surrounding tissue. There was no macroscopic involvement of the cervix, as the closest interspace between the cervix and the vaginal tumor was approximately 1 cm. The ulcer was freely mobile over the rectocele. The vulva was also normal, and so were the mucosal surfaces over other parts of the vagina and cervix (fig. 1). On bimanual examination the uterus was normal and mobile with free adnexa; no evidence of local spread was found. Rectal mucosa was free on rectal examination. The cervical smear was normal. Extensive workup, including chest X-ray, ultrasound, and contrast-enhanced CT of the abdomen, including the pelvis, did not reveal any other local genital cancer or metastasis. A diagnosis of stage I primary carcinoma of the vagina with third-degree uterovaginal prolapse was made, according to FIGO classification. The patient’s general health was very good, and her routine laboratory examinations were considered absolutely satisfactory for her age. A surgical treatment was proposed to her, and with her informed consent she underwent a vaginal hysterectomy with vaginal apex fixation, with partial vaginectomy to remove the vaginal carcinoma and anterior and posterior colporrhaphy. No lymph node dissection was performed. Histopathology confirmed a grade I squamous cell carcinoma of the vagina with superficial muscular layer invasion (fig. 2). The cervix showed chronic inflammation and hyperkeratinization. Fibromyoma uteri and all resection margins of the surgical specimen were clear. The distance of the tumor cells between surgical margins was 1.5 cm. She then underwent radiotherapy. The patient received external pelvic radiotherapy with 28 applications of 180 cGy/day (total dose of 5,040 cGy) and remained clinically free of recurrence or actinic complications during 4 years of follow-up in ambulatory care. There was no recurrent lesion or fistula forma-
142
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
tion during the follow-up. Only a mild urinary incontinence occurred after radiotherapy. Overall sexual satisfaction was decreased after treatment compared with that of preoperational conditions.
Discussion
Primary vaginal cancer is not common, representing 1–2% of all genital malignancies in women [1], and its incidence peaks between 60 and 80 years of age [3]. The tumor usually arises on the posterior wall of the upper third of vagina, and epidermoid carcinoma is the most common histological type observed [3–6]. Until recently, approximately 10 cases were reported on primary vaginal cancer complicated by uterine prolapse [4, 6–9] (table 1). It is usually squamous carcinoma and occurs in the upper third of vagina. Risk factors for developing vaginal carcinoma are associated with bacterial infection, trauma (especially after pessary or prolapse), and HPV exposure [7]. The combination of uterine prolapse and vaginal cancer is extremely rare. In 60% of the cases, the patients show symptoms for 10 years or more, prior to diagnosis [8]. Constant mechanical irritation caused by the uterine prolapse is one presumed risk factor. In our case, the patient had a 30-year history of uterine prolapse, indicating that it began long before any lesion could be observed, which suggests that the neoplasia appeared after the uterine prolapse. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration to exclude vaginal cancer. Generally speaking, for squamous cell cancers of vaginal cancer, radiation therapy is used for most stage I cancers. Removing part or the entire vagina is an option for some cancers (partial or radical vaginectomy). Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large portion of the vagina has been removed. Tarraza et al. [10] reported that upperthird lesions developed local recurrences more frequently, but lower-third lesions developed a relatively high number of sidewall and distant recurrences. Lesions to the posterior wall have a worse prognosis than those involving other vaginal walls [11, 12]. If the cancer is in the upper vagina, it may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, or radical or partial vaginectomy. Following a radical or partial vaginectomy, postoperative radiation (external beam) may be used to treat tiny deposits of cancer cells that have spread to lymph nodes in the pelvis. For stages II, III, or IV, the usual treatment is radiation therapy, and chemotherapy Wang /Li /Du /Lv /Liu
Color version available online
Color version available online
Fig. 1. Irreducible uterovaginal prolapse with vaginal carcinoma.
Fig. 2. A grade 1 squamous cell carcinoma of the vagina, with su-
perficial muscular layer invasion.
Table 1. Review of the literature on uterine prolapse complicated by vaginal cancer
First author Patient Histological Diagnosis age, years type
Type of operation
Other treatment
Rao [9], 1989
44
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
45
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
50
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
55
squamous
third-degree uterine prolapse with a FIGO stage III vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
61
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
refused treatment
refused treatment
Rao [9], 1989
72
squamous
third-degree uterine prolapse with a FIGO stage IV vaginal carcinoma
none
external telecobalt radiotherapy
Karateke [6], 68 2006
squamous
stage II vaginal carcinoma with third-degree uterovaginal prolapse
subtotal hysterectomy and bilateral salpingo-oophorectomy with the cervix bilaterally suspended to the pectineal ligaments by polypropylene mesh
radiotherapy
Iavazzo [4], 2007
80
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
radical vaginal hysterectomy and external excision of the upper two thirds of the radiotherapy vagina without pelvic lymphadenectomy
Gupta [7], 2007
60
squamous
third-degree uterovaginal prolapse with none a FIGO stage III vaginal carcinoma
chemoradiation
Ghosh [15], 50 2009
squamous
stage I primary carcinoma of the vagina radical vaginal hysterectomy with with third-degree uterovaginal prolapse bilateral extraperitoneal pelvic with cystocele and enterorectocele lymphadenectomy
none
Uterine Prolapse with Vaginal Cancer
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
143
might be combined with radiation to help it work better. The 5-year survival rate for stage I is 70–80%, as compared with 35–50, 35, and 20% for stages II, III, and IV, respectively. General speaking, a tendency toward more conservative surgical intervention is evident in the current management of many gynecologic malignancies. This is mainly due to the concern with morbidity and quality of life, and the trend for more individualization of treatment [13]. In China, the quality of life of cancer patients has increasingly been attracting attention from clinical doctors and healthcare professionals [14]. Older patients cannot endure more invasive operations. If radiotherapy is the first choice, the third-degree uterine prolapse will still be present. At the same time, the rate of rectovaginal fistula, vesicovaginal fistula, or fibrosis would increase because of the great dose of radiotherapy, which lowers the quality of life for the patients. In this case, we performed a vaginal hysterectomy to cure uterine prolapse, with partial vaginectomy to remove the vaginal carcino-
ma and anterior and posterior colporrhaphy, in addition to radiotherapy. Due to the rarity of this entity, the treatment was controversial according to the current and previous literature [4, 15]. We believe that surgical treatment with or without radiotherapy is the optimum treatment for early-stage vaginal carcinoma associated with uterine prolapse. Patients diagnosed with vaginal carcinoma complicated with uterine prolapse often have a history of prolapse of more than 10 years. The first complaint is usual vaginal bleeding, discharge, or ulceration. To conclude, surgery and radiotherapy can be effectively combined in patients with vaginal carcinoma and complete genital prolapse to reduce morbidity and improve quality of life.
Disclosure Statement The authors declare no conflicts of interest.
References 1 Fader AN, Brainard JA, Rose PG: Symptomatic vaginal bleeding in a postmenopausal woman: a case report of pancreatic adenocarcinoma metastasizing exclusively to the vagina. Am J Obstet Gynecol 2007;197:e8–e9. 2 De Vita D, Giordano S: Two successful natural pregnancies in a patient with severe uterine prolapse: a case report. J Med Case Rep 2011;5:459. 3 Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S: FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000;70:209–262. 4 Iavazzo C, Vorgias G, Vecchini G, Katsoulis M, Akrivos T: Vaginal carcinoma in a completely prolapsed uterus. A case report. Arch Gynecol Obstet 2007;275:503–505.
144
5 Creasman WT: Vaginal cancers. Curr Opin Obstet Gynecol 2005;17:71–76. 6 Karateke A, Tugrul S, Yakut Y, Gurbuz A, Cam C: Management of a case of primary vaginal cancer with irreducible massive uterine prolapse – a case report. Eur J Gynaecol Oncol 2006;27:528–530. 7 Gupta N, Mittal S, Dalmia S, Misra R: A rare case of primary invasive carcinoma of vagina associated with irreducible third degree uterovaginal prolapse. Arch Gynecol Obstet 2007;276:563–564. 8 Rocker I: Malignant changes in procidentia; the incidence during the years 1949–1954 at Addenbrooke’s Hospital, Cambridge. J Obstet Gynaecol Br Emp 1958;65:89–91. 9 Rao K, Kumar NP, Geetha AS: Primary carcinoma of vagina with uterine prolapse. J Indian Med Assoc 1989;87:10–12. 10 Tarraza MH Jr, Muntz H, Decain M, Granai OC, Fuller A Jr: Patterns of recurrence of primary carcinoma of the vagina. Eur J Gynaecol Oncol 1991;12:89–92.
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
11 Dixit S, Singhal S, Baboo HA: Squamous cell carcinoma of the vagina: a review of 70 cases. Gynecol Oncol 1993;48:80–87. 12 Chyle V, Zagars GK, Wheeler JA, Wharton JT, Delclos L: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1996; 35:891–905. 13 Meirovitz M, Sade S, Dreiher J, Shaco-Levy R: Is radical hysterectomy necessary in early cervical cancer? Gynecol Obstet Invest 2013; 76: 158–162. 14 Tian J: Sexual well-being of cervical cancer survivors under 50 years old and the factors affecting their libido. Gynecol Obstet Invest 2013;76:177–181. 15 Ghosh SB, Tripathi R, Mala YM, Khurana N: Primary invasive carcinoma of vagina with third degree uterovaginal prolapse: a case report and review of literature. Arch Gynecol Obstet 2009;279:91–93.
Wang /Li /Du /Lv /Liu
Copyright: S. Karger AG, Basel 2014. Reproduced with the permission of S. Karger AG, Basel. Further reproduction or distribution (electronic or otherwise) is prohibited without permission from the copyright holder.
Received: August 19, 2013 Accepted after revision: November 26, 2013 Published online: January 23, 2014
Uterine Prolapse Complicated by Vaginal Cancer: A Case Report and Literature Review Yueling Wang a Qiling Li a Huiping Du c Shulan Lv a Huiting Liu b a c
Department of Obstetrics and Gynecology, at b First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China; Fiscal Research Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Ga., USA
Established Facts • For squamous cell cancers of vaginal cancer, radiation therapy is used for most stage I vaginal cancers. Removing part or the entire vagina is an option for some cancers.
Novel Insights • Surgery and radiotherapy can be effectively combined in patients with vaginal carcinoma and complete genital prolapse for reducing morbidity and improving quality of life. • We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration to exclude vaginal cancer.
Key Words Uterine prolapse · Vaginal cancer · Diagnosis · Treatment
Abstract Primary vaginal cancer is not common, representing 1–2% of all female genital malignancies. We present a case of a third-degree uterine prolapse complicated by an isolated primary vaginal cancer and its surgical treatment. The cervix was clinically normal, but on the nearby prolapsed vaginal wall, a large exogenous hard lesion had developed. A biopsy of the lesion revealed a squamous carcinoma. The patient
© 2014 S. Karger AG, Basel 0378–7346/14/0772–0141$39.50/0 E-Mail [email protected] www.karger.com/goi
was asymptomatic and had no recurrence during the last 4 years of follow-up after surgical treatment with radiotherapy. The surgical treatment with or without radiotherapy is the optimum treatment for uterine prolapse with early-stage vaginal squamous cell carcinoma, although the majority of vaginal malignancies are treated with radiotherapy. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration. © 2014 S. Karger AG, Basel
Yueling Wang and Qiling Li contributed equally to this work.
Qiling Li, MD, PhD First Affiliated Hospital, Xi’an Jiaotong University 277 Yanta West Road Xi’an, Shaanxi 710061 (China) E-Mail liqilinglady @ 163.com
Introduction
Most vaginal malignancies are metastatic, arising most commonly from other pelvic organs, such as the ovaries, endometrium and cervix. Primary vaginal cancer is not common, representing 1–2% of all genital malignancies in women [1]. Reviewing the literature on uterine prolapse reported before 1970, we found that most cases of uterine prolapse are located in economically undeveloped areas, where grand multiparity is more common [2]. We present this rare case of severe uterine prolapse complicated by primary vaginal cancer.
Case Report A 61-year-old Chinese woman, gravida 5, para 4, presented with a 30-year history of a painless vaginal mass without a history of cervical intraepithelial carcinoma. The HPV infection status was not known. She was not using a pessary. The vagina was enlarged, and the patient had suffered difficulty urinating during the preceding 10 years. Biopsy of the vaginal ulcer, performed at another hospital, revealed squamous cell carcinoma of the vagina. Local examination revealed a third-degree uterovaginal prolapse. A 7 × 5 cm ulcer was present on the upper third of the right lateral vaginal wall, with marked induration of the surrounding tissue. There was no macroscopic involvement of the cervix, as the closest interspace between the cervix and the vaginal tumor was approximately 1 cm. The ulcer was freely mobile over the rectocele. The vulva was also normal, and so were the mucosal surfaces over other parts of the vagina and cervix (fig. 1). On bimanual examination the uterus was normal and mobile with free adnexa; no evidence of local spread was found. Rectal mucosa was free on rectal examination. The cervical smear was normal. Extensive workup, including chest X-ray, ultrasound, and contrast-enhanced CT of the abdomen, including the pelvis, did not reveal any other local genital cancer or metastasis. A diagnosis of stage I primary carcinoma of the vagina with third-degree uterovaginal prolapse was made, according to FIGO classification. The patient’s general health was very good, and her routine laboratory examinations were considered absolutely satisfactory for her age. A surgical treatment was proposed to her, and with her informed consent she underwent a vaginal hysterectomy with vaginal apex fixation, with partial vaginectomy to remove the vaginal carcinoma and anterior and posterior colporrhaphy. No lymph node dissection was performed. Histopathology confirmed a grade I squamous cell carcinoma of the vagina with superficial muscular layer invasion (fig. 2). The cervix showed chronic inflammation and hyperkeratinization. Fibromyoma uteri and all resection margins of the surgical specimen were clear. The distance of the tumor cells between surgical margins was 1.5 cm. She then underwent radiotherapy. The patient received external pelvic radiotherapy with 28 applications of 180 cGy/day (total dose of 5,040 cGy) and remained clinically free of recurrence or actinic complications during 4 years of follow-up in ambulatory care. There was no recurrent lesion or fistula forma-
142
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
tion during the follow-up. Only a mild urinary incontinence occurred after radiotherapy. Overall sexual satisfaction was decreased after treatment compared with that of preoperational conditions.
Discussion
Primary vaginal cancer is not common, representing 1–2% of all genital malignancies in women [1], and its incidence peaks between 60 and 80 years of age [3]. The tumor usually arises on the posterior wall of the upper third of vagina, and epidermoid carcinoma is the most common histological type observed [3–6]. Until recently, approximately 10 cases were reported on primary vaginal cancer complicated by uterine prolapse [4, 6–9] (table 1). It is usually squamous carcinoma and occurs in the upper third of vagina. Risk factors for developing vaginal carcinoma are associated with bacterial infection, trauma (especially after pessary or prolapse), and HPV exposure [7]. The combination of uterine prolapse and vaginal cancer is extremely rare. In 60% of the cases, the patients show symptoms for 10 years or more, prior to diagnosis [8]. Constant mechanical irritation caused by the uterine prolapse is one presumed risk factor. In our case, the patient had a 30-year history of uterine prolapse, indicating that it began long before any lesion could be observed, which suggests that the neoplasia appeared after the uterine prolapse. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration to exclude vaginal cancer. Generally speaking, for squamous cell cancers of vaginal cancer, radiation therapy is used for most stage I cancers. Removing part or the entire vagina is an option for some cancers (partial or radical vaginectomy). Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large portion of the vagina has been removed. Tarraza et al. [10] reported that upperthird lesions developed local recurrences more frequently, but lower-third lesions developed a relatively high number of sidewall and distant recurrences. Lesions to the posterior wall have a worse prognosis than those involving other vaginal walls [11, 12]. If the cancer is in the upper vagina, it may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, or radical or partial vaginectomy. Following a radical or partial vaginectomy, postoperative radiation (external beam) may be used to treat tiny deposits of cancer cells that have spread to lymph nodes in the pelvis. For stages II, III, or IV, the usual treatment is radiation therapy, and chemotherapy Wang /Li /Du /Lv /Liu
Color version available online
Color version available online
Fig. 1. Irreducible uterovaginal prolapse with vaginal carcinoma.
Fig. 2. A grade 1 squamous cell carcinoma of the vagina, with su-
perficial muscular layer invasion.
Table 1. Review of the literature on uterine prolapse complicated by vaginal cancer
First author Patient Histological Diagnosis age, years type
Type of operation
Other treatment
Rao [9], 1989
44
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
45
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
50
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
55
squamous
third-degree uterine prolapse with a FIGO stage III vaginal carcinoma
none
external telecobalt radiotherapy
Rao [9], 1989
61
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
refused treatment
refused treatment
Rao [9], 1989
72
squamous
third-degree uterine prolapse with a FIGO stage IV vaginal carcinoma
none
external telecobalt radiotherapy
Karateke [6], 68 2006
squamous
stage II vaginal carcinoma with third-degree uterovaginal prolapse
subtotal hysterectomy and bilateral salpingo-oophorectomy with the cervix bilaterally suspended to the pectineal ligaments by polypropylene mesh
radiotherapy
Iavazzo [4], 2007
80
squamous
third-degree uterine prolapse with a FIGO stage I vaginal carcinoma
radical vaginal hysterectomy and external excision of the upper two thirds of the radiotherapy vagina without pelvic lymphadenectomy
Gupta [7], 2007
60
squamous
third-degree uterovaginal prolapse with none a FIGO stage III vaginal carcinoma
chemoradiation
Ghosh [15], 50 2009
squamous
stage I primary carcinoma of the vagina radical vaginal hysterectomy with with third-degree uterovaginal prolapse bilateral extraperitoneal pelvic with cystocele and enterorectocele lymphadenectomy
none
Uterine Prolapse with Vaginal Cancer
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
143
might be combined with radiation to help it work better. The 5-year survival rate for stage I is 70–80%, as compared with 35–50, 35, and 20% for stages II, III, and IV, respectively. General speaking, a tendency toward more conservative surgical intervention is evident in the current management of many gynecologic malignancies. This is mainly due to the concern with morbidity and quality of life, and the trend for more individualization of treatment [13]. In China, the quality of life of cancer patients has increasingly been attracting attention from clinical doctors and healthcare professionals [14]. Older patients cannot endure more invasive operations. If radiotherapy is the first choice, the third-degree uterine prolapse will still be present. At the same time, the rate of rectovaginal fistula, vesicovaginal fistula, or fibrosis would increase because of the great dose of radiotherapy, which lowers the quality of life for the patients. In this case, we performed a vaginal hysterectomy to cure uterine prolapse, with partial vaginectomy to remove the vaginal carcino-
ma and anterior and posterior colporrhaphy, in addition to radiotherapy. Due to the rarity of this entity, the treatment was controversial according to the current and previous literature [4, 15]. We believe that surgical treatment with or without radiotherapy is the optimum treatment for early-stage vaginal carcinoma associated with uterine prolapse. Patients diagnosed with vaginal carcinoma complicated with uterine prolapse often have a history of prolapse of more than 10 years. The first complaint is usual vaginal bleeding, discharge, or ulceration. To conclude, surgery and radiotherapy can be effectively combined in patients with vaginal carcinoma and complete genital prolapse to reduce morbidity and improve quality of life.
Disclosure Statement The authors declare no conflicts of interest.
References 1 Fader AN, Brainard JA, Rose PG: Symptomatic vaginal bleeding in a postmenopausal woman: a case report of pancreatic adenocarcinoma metastasizing exclusively to the vagina. Am J Obstet Gynecol 2007;197:e8–e9. 2 De Vita D, Giordano S: Two successful natural pregnancies in a patient with severe uterine prolapse: a case report. J Med Case Rep 2011;5:459. 3 Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S: FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000;70:209–262. 4 Iavazzo C, Vorgias G, Vecchini G, Katsoulis M, Akrivos T: Vaginal carcinoma in a completely prolapsed uterus. A case report. Arch Gynecol Obstet 2007;275:503–505.
144
5 Creasman WT: Vaginal cancers. Curr Opin Obstet Gynecol 2005;17:71–76. 6 Karateke A, Tugrul S, Yakut Y, Gurbuz A, Cam C: Management of a case of primary vaginal cancer with irreducible massive uterine prolapse – a case report. Eur J Gynaecol Oncol 2006;27:528–530. 7 Gupta N, Mittal S, Dalmia S, Misra R: A rare case of primary invasive carcinoma of vagina associated with irreducible third degree uterovaginal prolapse. Arch Gynecol Obstet 2007;276:563–564. 8 Rocker I: Malignant changes in procidentia; the incidence during the years 1949–1954 at Addenbrooke’s Hospital, Cambridge. J Obstet Gynaecol Br Emp 1958;65:89–91. 9 Rao K, Kumar NP, Geetha AS: Primary carcinoma of vagina with uterine prolapse. J Indian Med Assoc 1989;87:10–12. 10 Tarraza MH Jr, Muntz H, Decain M, Granai OC, Fuller A Jr: Patterns of recurrence of primary carcinoma of the vagina. Eur J Gynaecol Oncol 1991;12:89–92.
Gynecol Obstet Invest 2014;77:141–144 DOI: 10.1159/000357566
11 Dixit S, Singhal S, Baboo HA: Squamous cell carcinoma of the vagina: a review of 70 cases. Gynecol Oncol 1993;48:80–87. 12 Chyle V, Zagars GK, Wheeler JA, Wharton JT, Delclos L: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1996; 35:891–905. 13 Meirovitz M, Sade S, Dreiher J, Shaco-Levy R: Is radical hysterectomy necessary in early cervical cancer? Gynecol Obstet Invest 2013; 76: 158–162. 14 Tian J: Sexual well-being of cervical cancer survivors under 50 years old and the factors affecting their libido. Gynecol Obstet Invest 2013;76:177–181. 15 Ghosh SB, Tripathi R, Mala YM, Khurana N: Primary invasive carcinoma of vagina with third degree uterovaginal prolapse: a case report and review of literature. Arch Gynecol Obstet 2009;279:91–93.
Wang /Li /Du /Lv /Liu
Copyright: S. Karger AG, Basel 2014. Reproduced with the permission of S. Karger AG, Basel. Further reproduction or distribution (electronic or otherwise) is prohibited without permission from the copyright holder.
