Article Text
PDF
Abstract
Introduction/Background Primary vaginal cancer is a rare occurrence, accounting for only 2% of gynaecologic malignancies in adults.1 The most common clinical presentation of vaginal cancer is postcoital and/or postmenopausal bleeding but it has been reported that up to 20% of patients may be asymptomatic.2
Methodology A 67-year-old patient presented with one episode of postmenopausal bleeding which resolved spontaneously on a background of previous hysterectomy and bilateral salpingo-oophorectomy 22 years ago for persistent CIN and VAIN. In addition, she had posterior vaginal wall repair and sacrospinous fixation 5 years ago. On examination, there were no abnormalities detected, with no lesions seen in the vagina. However, CT and MRI scans demonstrated a pocket of fluid within the left side of the vaginal vault (see figure 1). A biopsy from the area was attempted in clinic, unsuccessfully, therefore laparoscopy was performed. Intraoperatively, the disease was found to extend to the left ureter and the resected tissue confirmed the diagnosis of p16 positive squamous cell carcinoma of the vagina. A PET CT scan, performed after the operation, showed possible residual disease greater than 5mm, hence, plan was made for radical chemoradiotherapy and brachytherapy.
Results As per recent ESTRO/ESGO/SIOPe guidelines on management of vaginal cancer, pelvic MRI is the recommended imaging to determine local extent.[2] In this case, although MRI scan was done prior to surgery, it only showed small fluid collection. This atypical finding on the scan could have been attributed to the prolapse repair surgery, which potentially sealed and hid the area where the cancer was developing.
Conclusion This case demonstrated a rare imaging finding of vaginal cancer, which would be disregarded if the history of CIN was missed or if the scan findings were regarded as postoperative collection. The importance of medical history and proper investigation of symptoms with a multidisciplinary approach is emphasised.
Disclosures None
References
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–49. doi:10.3322/caac.21660
Nout R, Calaminus G, Planchamp F, Chargari C, Lax SF, Martelli H, McCluggage WG, Morice P, Pakiz M, Schmid MP, Stunt J. ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer. Radiotherapy and Oncology. 2023 May 25:109662.
