Introduction/Background Primary carcinoma of the vagina is rare and accounts for 1% of gynecologic malignancies. Adenocarcinoma is the second most common primary cancer in the vagina. Although less common than squamous cell carcinoma, it represents 15% of all primary vaginal malignancies. The most common manifestation of this malignancy is vaginal bleeding. Specific criteria in establishing endometriosis-related malignancy as presented by Sampson include the presence of benign endometrial and malignant tissue at the same site, the presence of endometrial stroma surrounding glands, and the exclusion of metastasis from another primary site.

• Download figure
• Open in new tab
• Download powerpoint

Abstract #338 Figure 1

Methodology This is a case of a 63-year old G1P1 (1001), who presented with postmenopausal bleeding. She had a history of total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis 20 years ago. A 3 cm vaginal mass was appreciated on internal examination. Vaginal stump biopsy and immunohistochemical stains revealed vaginal endometrioid adenocarcinoma. Positron emission topography (PET) scan showed no metastasis; hence, surgical intervention was advised. The patient underwent peritoneal fluid sampling, excision of vaginal mass, vaginectomy, bilateral lymph node dissection, omentectomy under combined regional – general anesthesia where in histopathology revealed vaginal endometrioid adenocarcinoma, grade III.

Results Primary endometrioid adenocarcinoma of the vagina is the second most common subtype of vaginal adenocarcinoma and accounts to 8–10% of cases. In majority of cases, it is seen in association with endometriosis, which is a finding that helps in the exclusion of metastatic disease. Treatment of vaginal carcinoma depends primarily on histology, tumor volume, anatomic location, stage, and age of the patient. The origin, natural history, malignant transformation, and laboratory management of endometriosis are not yet clearly investigated.

Conclusion Strategies for prevention, early detection, specific diagnosis, and treatment should be set up targeting the pathogenesis of endometriosis to better understand endometriosis-associated cancer.

Disclosures None