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13. Vaginal and vulvar cancer
334 Primary intestinal type adenocarcinoma of the vagina: molecular characteristics and treatment considerations
  1. Aikaterini Liapi1,
  2. Delfyne Hastir2,
  3. Patrice Mathevet3,
  4. Fernanda Herrera4 and
  5. Apostolos Sarivalasis1
  1. 1Department of Medical Oncology, Specialized clinic of Gynaecological Malignancies, Center of Gynaecological Tumors, Lausanne University Hospital – CHUV (Lausanne), Switzerland, Lausanne, Switzerland
  2. 2Department of Pathology, Center of Gynaecological Malignancies, CHUV (Lausanne), Switzerland, Lausanne, Switzerland
  3. 3Department of Gynecology, Center of Gynaecological Tumors, Lausanne University Hospital – CHUV (Lausanne), Switzerland, Lausanne, Switzerland
  4. 4Department of Radiotherapy, Lausanne University Hospital CHUV, Lausanne, Switzerland, Lausanne, Switzerland

Abstract

Introduction/Background Primary intestinal adenocarcinoma of the vagina is an extremely rare form of vaginal cancer. Staging is based on the clinical features using the International Federation of Gynecology and Obstetrics (FIGO) and TNM system. No definitive treatment recommendations are available and thus treatment is often inspired from other primary adenocarcinomas of the region.

Methodology A 48-year-old patient was admitted for vaginal bleeding and abdominal pain. The pelvic MRI showed a malignant mass, infiltrating the vagina, the cervix, and the bladder. The diagnostic biopsy showed an HPV-independent adenocarcinoma of intestinal type. On immunohistochemistry the cancer was positive for CK20, CK7 and p16, but negative for GATA3, ER and PR. A bladder carcinoma was excluded, based on immunohistochemistry, imaging, and cystoscopy findings. The PET-CT was negative for lymph node and distant metastases. The stage was a FIGO IVA vaginal adenocarcinoma. Due to the local extension, a radical surgical excision was not possible, thus a concomitant chemoradiation by weekly cisplatin at 40 mg/m2 in combination with 45Gy radiotherapy in 25 fractions of 1.8Gy and brachytherapy was initiated, following a literature review

Results The MRI performed at the end of chemoradiation showed partial response (PR), persisting at the control by PET-CT at three months. Surgical rescue was not performed as it would be extremely mutilating. Due to the PR, a next generation sequencing (NGS) with 52 genes panel was performed and detected the following variations: KRAS exon 2, TP53 exon 8, CDKN2A exon 2 mutation and SMAD4 deletion.

Conclusion Chemoradiation is effective for local tumor control but was unable to provide a complete response in the 3-month assessment. To personalize future therapeutic options, we performed a NGS sequencing to improve our knowledge and report them in this abstract. The mutations could not be therapeutically targeted but contributed to a better understanding of the disease and familial genetic testing.

Disclosures No disclosures for the authors.

Abstract 334 Figure 1
Abstract 334 Figure 1

https://doi.org/10.1136/ijgc-2024-ESGO.1041

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