Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report.
Long-term surveillance of the vaginal stump is crucial for early detection of lesions in patients who have undergone total hysterectomy for benign diseases.
Where it sits
this study against the rest of the goserelin corpusSummary and findings
This report describes a case of primary vaginal endometrioid adenocarcinoma in a 49-year-old female who had a total hysterectomy for adenomyosis three years prior. The patient presented with postcoital vaginal bleeding, and a biopsy confirmed low-grade adenocarcinoma. Following surgery and chemoradiotherapy, the patient was in good condition with no recurrence at the last follow-up of 15 months.
Abstract
Primary vaginal cancer is a rare malignant tumor; its pathogenesis remains unclear and only a limited number of cases have been documented in the literature. The present report outlines a rare case of primary vaginal endometrioid adenocarcinoma that occurred in a patient 3 years after a total hysterectomy for uterine adenomyosis. Pathogenesis, clinical features, diagnosis, treatment and prognosis are discussed to improve clinical recognition and management of this rare condition. A 49-year-old female patient who had undergone a total hysterectomy for uterine adenomyosis 3 years earlier presented with postcoital vaginal bleeding. Gynecological examination identified a mass in the vaginal stump. A biopsy revealed low-grade vaginal adenocarcinoma. The patient underwent an extensive laparoscopic parametric resection, partial upper vaginectomy, pelvic lymph node dissection and bilateral oophorectomy. The postoperative pathology determined a diagnosis of primary vaginal endometrioid adenocarcinoma. Concurrent chemoradiotherapy was initiated 6 weeks after surgery. At the last follow-up (15 months postoperatively), the patient was in good general condition with no evidence of recurrence. The present case indicates that long-term surveillance of the vaginal stump is valuable for patients who have undergone total hysterectomy for benign uterine diseases, as it allows early detection of vaginal stump lesions. In particular, for patients with a history of other malignant tumors, specific attention should be paid to the genetic susceptibility of the underlying tumor.
Background
Primary vaginal cancer is rare, and its pathogenesis is not well understood. Prior literature has documented limited cases, emphasizing the need for awareness and management strategies. This case report aims to enhance clinical recognition and understanding of primary vaginal endometrioid adenocarcinoma following hysterectomy for benign conditions.
Methods
This is a case report detailing the clinical course of a single patient. The patient underwent a total hysterectomy for adenomyosis three years prior to presentation. Following the diagnosis of low-grade vaginal adenocarcinoma, she received extensive surgical intervention and concurrent chemoradiotherapy.
Results
The primary endpoint was the diagnosis of low-grade vaginal adenocarcinoma confirmed by biopsy. The patient underwent extensive surgical procedures, including laparoscopic parametric resection and pelvic lymph node dissection. At the last follow-up, 15 months post-surgery, there was no evidence of cancer recurrence.
Interpretation
This case adds to the limited literature on primary vaginal adenocarcinoma and highlights the importance of long-term surveillance in patients with a history of hysterectomy for benign conditions. While the patient had no recurrence at follow-up, the small sample size and nature of a case report limit the ability to draw broader conclusions. Practitioners should consider individual patient histories and genetic factors when monitoring for potential malignancies.
Key findings
- A 49-year-old female presented with postcoital vaginal bleeding.
- Biopsy revealed low-grade vaginal adenocarcinoma.
- The patient underwent extensive laparoscopic surgery and concurrent chemoradiotherapy.
- At 15 months postoperatively, the patient had no evidence of recurrence.
Limitations
- Single case report limits generalizability.
- Long-term outcomes based on a single patient's experience.
- Not applicable for broader patient populations.