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Updated: Aug 26 2019

Vaginal Carcinoma

  • Snapshot
    • A 62-year-old woman reports having abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles. Pelvic examination is notable for a vaginal mass. She underwent a vaginal biopsy that was remarkable for squamous cell carcinoma.
  • Introduction
    • Overview
      • malignancy affecting the vagina
        • most common histologic type is squamous cell carcinoma
          • most commonly secondary to squamous cell carcinoma of the cervix
    • Epidemiology
      • incidence
        • comprises ~3% of all malignancies involving the female genital tract
        • mean age of diagnosis is ~60 years
      • risk factors
        • human papillomavirus (HPV) infection
        • extension from malignant cervical disease
        • diethylstilbestrol (DES)
          • associated with adenocarcinoma of the vagina
  • Presentation
    • Symptoms
      • vaginal bleeding (most common)
        • may be postcoital, intermenstrual, or postmenopausal
    • Physical exam
      • vaginal mass may be noted
  • Studies
    • Lab studies
      • vaginal cytology
    • Invasive studies
      • vaginal colposcopy
        • indication
          • performed if cytology is abnormal
      • vaginal biopsy
        • indication
          • confirms the diagnosis
    • Histology
      • squamous cell carcinoma
        • most common histological type
      • clear cell adenocarcinoma
        • secondary to DES exposure in utero
        • typically presents in women < 20 years of age
      • sarcoma botryoides ("botrys" is Greek for "grapes")
        • affecting girls < 4 years of age
        • appears as a polypoid (or grape-like) mass that emerges from the vagina
        • contains spindle-shaped cells that are positive for desmin
  • Differential
    • Cervical cancer
      • differentiating factors
        • evidence of dysplastic or malignat cells in the cervix only
  • Treatment
    • Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor
  • Complications
    • Teatment-related complications
      • rectal and vaginal strictures
      • urethral, bladder, and/or rectal injury
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