Tumor del saco vitelino primario de vagina en una niña. A propósito de un caso / Primary vaginal yolk sac tumor in a girl. Case report

Las neoplasias ginecológicas en niñas son raras. Representan menos del 5 % de todos los cánceres en pediatría. No existen estadísticas sobre la incidencia de tumores de vagina en esta etapa de la vida. Se presenta el caso de una niña de 9 meses con sangrado por genitales. La ecografía evidencia una masa sólida en vagina, y la vaginoscopia, un tumor friable. Presenta valores de α-fetoproteína elevados, por lo que se diagnostica tumor de saco vitelino, confirmado por biopsia. Se realiza tratamiento quimioterápico. A menos de 1 año del diagnóstico, se encuentra en remisión completa. Este caso resulta de interés no solo por la rareza, sino también porque el diagnóstico rápido de tumor de saco vitelino permite mejorar los resultados y la sobrevida de las pacientes

Gynecological neoplasms in girls are rare and represent only less than 5 % of all childhood tumors. There are no statistics on the incidence of vaginal tumors at this stage in life. We present a 9-month-old girl evaluated for genital bleeding. Ultrasound reveals a vaginal solid mass and vaginoscopy reports a friable tumor. AFP is elevated. A yolk sac tumor is confirmed by biopsy she receives chemotherapy. Within a year after diagnosis, she remains tumor-free. This is a case of interest, not only because of its rarity, but also because a rapid diagnosis of a yolk sac tumor improves outcomes and patient's survival rates.

Leiomiomatosis vulvovaginal: reporte de un caso y revisión bibliográfica / Vulvo-Vaginal Leiomyomatosis: Case Report and Review of the Literature

Resumen ANTECEDENTES: Los leiomiomas son los tumores pélvicos más frecuentes en la mujer; sin embargo, su localización vaginal es excepcional. Suelen ser asintomáticos y encontrarse como un hallazgo clínico. En los últimos 20 años solo se han reportado 85 casos, y solo dos han sido recurrentes. OBJETIVO: Reportar un caso de miomatosis vaginal recurrente en una paciente histerectomizada y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 58 años, histerectomizada, con una tumoración vaginal. El reporte histopatológico informó una proliferación fusocelular, debidamente delimitada, dispuesta en haces entrecruzados. Los núcleos eran alargados, monomorfos y de extremos romos. El estroma era escaso y colagénico. No se observaron atipias citonucleares ni necrosis. El estudio inmunohistoquímico de la lesión con actina de anticuerpos antimúsculo liso y desmina se reportó positivo. Se diagnosticó miomatosis vulvovaginal recurrente. Se trató mediante resección quirúrgica. CONCLUSIÓN: Los leiomiomas vulvovaginales son extremadamente raros y la bibliografía al respecto es poca; su recurrencia es verdaderamente excepcional. De ahí la importancia de la publicación de estos casos, que aporta información que pueden tomar en cuenta otros clínicos al momento del diagnóstico.

Abstract BACKGROUND: Leiomyomas are the most frequent pelvic tumors in women; however, their vaginal location is unusual. They are usually asymptomatic and present as a clinical finding. In the last 20 years only 85 cases have been reported, and only two have been recurrent. OBJECTIVE: To report a case of recurrent vaginal myomatosis in a hysterectomized patient and review the literature. CLINICAL CASE: A 58-year-old hysterectomized patient with a vaginal tumor. The histopathologic report reported a fusocellular proliferation, properly delimited, arranged in crisscross bundles. The nuclei were elongated, monomorphous and blunt ended. The stroma was sparse and collagenous. No cytonuclear atypia or necrosis were observed. Immunohistochemical study of the lesion with anti-smooth muscle antibody actin and desmin was reported positive. Recurrent vulvovaginal myomatosis was diagnosed. It was treated by surgical resection. CONCLUSION: Vulvovaginal leiomyomas are extremely rare, and the literature is sparse; their recurrence is truly exceptional. Hence the importance of publishing these cases, providing information to be considered by other clinicians at the time of diagnosis.

Application of vaginoscopy in the diagnosis and treatment of occult vaginal high-grade squamous intraepithelial lesions / 中华妇产科杂志

Objective:To investigate the application value of vaginoscopy in the diagnosis and treatment of vaginal squamous intraepithelial lesions post hysterectomy.Methods:From May 2017 to June 2020, patients with high-risk (HR)-HPV infection and (or) cytological abnormalities after hysterectomy in Obstetrics and Gynecology Hospital Affiliated to Fudan University were examined by colposcopy, and those who were not satisfied with exposure under colposcopy were further examined by vaginoscopy. The role of vaginoscopy in the detection and treatment of occult vaginal squamous intraepithelial lesions was analyzed.Results:A total of 153 patients with HR-HPV infection and (or) cytological abnormalities, and inadequate colposcopy were enrolled in this study. The average age was (49.8±8.1) years. All cases were successfully performed vaginoscopy with no vaginal perforation, no bladder and intestinal injury. During vaginoscopy, 11 (7.2%, 11/153) cases with unclear high-grade squamous intraepithelial lesion (HSIL) boundary under colposcopy were found with clear HSIL boundary, and new HSIL was found in 23 (15.0%, 23/153) cases. According to colposcopy, there were 89 cases of normal or inflammation, 45 cases of vaginal low-grade squamous intraepithelial lesion (LSIL) and 19 cases of vaginal HSIL. According to vaginoscopy, there were 56 cases of normal or chronic inflammation, 55 cases of vaginal LSIL, 40 cases of vaginal HSIL (including 2 cases of vaginal HSIL could not exclude cancer) and 2 cases of vaginal carcinoma. There were significant difference between colposcopy and vaginoscopy ( P<0.01). The missed diagnosis rate of vaginal apex blind curettage under colposcopy was 54.8%. For the 40 cases with vaginal HSIL under vaginoscopy, 15 cases were completely curettaged with vaginal endoscopic claw forceps, and 22 cases were vaporized by Versapoint. Among the 37 cases of vaginal HSIL treated by vaginoscopy, 34 cases were followed up for 6 months with 31 cases of vaginal HSIL cured. The cure rate was 91.2% (31/34), the positive rate of HR-HPV decreased from 100.0% (34/34) to 79.4% (27/34). Conclusion:For patients with inadequate exposure of vaginal apex during colposcopy posthysterectomy, vaginoscopy is helpful to detect the occult lesions in the vaginal apex, and it could also be used for the treatment of vaginal squamous intraepithelial lesions.

Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review / Carcinoma epidermoide de neovagina en paciente con síndrome de mayer- rokitansky-küster-hauser. reporte de un caso y revisión de la literatura

RESUMEN Objetivo: presentar el caso de una paciente con síndrome de Mayer-Rokitansky-Küster-Hauser, con diagnóstico de carcinoma escamoso en neovagina, y realizar una revisión de la literatura del tratamiento y pronóstico de las neoplasias o la infección por VPH de tejidos neovaginales en mujeres transgénero o con síndrome MRKH. Materiales y métodos: mujer de 56 años de edad que consulta en un hospital universitario regional de la ciudad de Sevilla (España). Tras la exploración clínica se aprecia una tumoración exofítica en fondo de vagina, con resultado de biopsia de carcinoma escamoso y cultivo positivo para virus del papilloma humano (VPH) tipo 16. Se realizó una búsqueda bibliográfica en la base de datos Medline vía PubMed, con los términos: "congenital abnormalities"; "mullerian aplasia"; "neovagina"; "vaginal neoplasms"; "squamous carcinoma"; "HPV infection", de reportes y series de caso, y estudios observacionales publicados desde el año 2000 hasta octubre de 2019 en inglés y español. Resultados: se incluyeron 14 estudios; de estos, siete correspondieron a carcinoma escamocelular, tres a adenocarcinoma y cuatro informan infección solo por VPH. Todos los carcinomas escamocelulares presentaban estadios avanzados por compromiso local o linfático y recibieron radioterapia con quimioterapia concomitante o cirugía radical. El pronóstico fue malo en tres de los casos. Las pacientes con adenocarcinoma también presentaron lesiones avanzadas con compromiso local, el tratamiento fue quirúrgico, con quimioterapia concomitante en dos de los casos. Solo una paciente tuvo seguimiento mayor a cinco años. La infección por VPH es frecuente en mujeres sometidas a construcción de neovagina. Conclusiones: las pacientes con neovagina son susceptibles de desarrollar carcinomas escamosos si se utilizaron injertos cutáneos, o adenocarcinomas en aquellas en las que se reconstruyó la vagina a partir de injertos tisulares intestinales. Dado que al momento del diagnóstico presentan compromiso local, a menudo requieren tratamientos radicales o combinados. Se debe investigar cuáles son las mejores estrategias de tamizaje de VPH, cáncer escamoso y adenocarcinoma en este tipo de pacientes.

ABSTRACT Objective: To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods: A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the following terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results: 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compromise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions: Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.

Postpartum genital melanoma - A case report / Melanoma genital pós-parto - relato de caso

Abstract Melanomas of the female genital tract may occur in the vulva, the vagina, the ovary or the cervix.Pregnancy has been considered an aggravating factor in the evolution and prognosis of melanoma. A 35-year-old female presented with vaginal bleeding 2 months after a term cesarean delivery. An endovaginal ultrasound revealed a lesion in the uterine cervix. The pathological report revealed a small round-cell neoplasm, and the immunohistochemistry confirmed the diagnosis of malignant melanoma. A positron emission tomography revealed an expansive hypermetabolic lesion centered on the cervix, and hypermetabolic lesions in the liver and right kidney. Non-surgical treatment was provided, with biochemotherapy followed by ipilimumab and nivolumab. The patient died one year later. Postpartum vaginal bleeding, even if late-onset, should be investigated, as it may be a pregnancy-associated malignant melanoma, which has a poor prognosis.

Resumo Melanomas do trato ginecológico podem ocorrer na vulva, vagina, ovário ou cérvix. A gravidez é considerada um fator agravante na evolução e prognóstico do melanoma. Uma mulher de 35 anos de idade apresentou sangramento vaginal 2 meses após o parto por cesariana a termo. Uma ultrassonografia endovaginal mostrou lesão no colo uterino. O exame anatomopatológico mostrou uma pequena neoplasia de células redondas, e a imuno-histoquímica confirmou o diagnóstico de melanoma maligno. A tomografia por emissão de pósitrons mostrou lesão hipermetabólica expansiva centrada no colo do útero,e lesões hipermetabólicas no fígado e no rim direito. O tratamento não cirúrgico foi feito com bioquimioterapia seguida de ipilimumab e nivolumab. A paciente morreu um ano depois. Sangramentos vaginais pós-parto,mesmo que tardios,devem ser investigados,pois podem ser um melanoma maligno associado à gravidez, o qual tem um mau prognóstico.

Analysis of the factors associated with the long-term curative effect and prognosis of primary vaginal carcinoma / 中华肿瘤杂志

Objective@#To investigate the clinical factors that affect the prognosis of patients with primary vaginal cancer.@*Methods@#Clinical data of 118 primary vaginal cancer patients with pathological diagnosis and clinical follow-up data from the Department of Gynecology of Liaoning Cancer Hospital & Institute from 1999 to 2014 were collected and retrospectively analyzed. The relationship of prognosis and factors including age, history of hysterectomy, pathological types, International Federation of Gynecology and Obstetrics (FIGO) stage, tumor size, tumor location and therapeutic methods were analyzed, respectively.@*Results@#The median survival time of the 118 patients was 93 months. The survival rates of 1, 3, 5, 10 and 15-year were 89.7%, 68.1%, 60.4%, 37.3% and 19.0%, respectively.The results of univariate analysis showed that the FIGO stage, pathological types, tumor size, therapeutic methods and tumor location were related to the prognosis of patients with primary vaginal cancer (all P<0.05), while the patients′ age, history of hysterectomy were not (all P>0.05). The results of Cox multivariate regression analysis indicated that FIGO stage (P=0.008), tumor location (P=0.001) and therapeutic methods (P=0.007) were independent prognostic factors of the patients with primary vaginal cancer.@*Conclusions@#Prognostic factorsofpatients with primary vaginal cancer include FIGO stage, pathological types, tumor size, therapeutic methods and tumor location. Among them, therapeutic methods and tumor location are the independent prognostic factors.

Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09) / 부인종양

OBJECTIVE: To assess the outcome of the treatment of primary vaginal cancer using definitive radiotherapy (RT) and to evaluate the prognostic factors of survival. METHODS: The medical records of nine institutions were retrospectively reviewed to find the patients with vaginal cancer treated with definitive RT with or without chemotherapy. A total of 138 patients met the inclusion criteria. None had undergone curative excision. RESULTS: The median follow-up time of the survivors was 77.6 months and the median survival time was 46.9 months. The 5-year overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) rates were 68%, 80%, and 68.7%, respectively. In the survival analysis, the multivariate analysis showed that a lower the International Federation of Gynecology and Obstetrics (FIGO) stage and prior hysterectomy were favorable prognostic factors of CSS, and a lower FIGO stage and diagnosed prior to year 2000 were favorable prognostic factors of PFS. In the subgroup analysis of the patients with available human papillomavirus (HPV) results (n=27), no statistically significant relationship between the HPV status and recurrence or survival was found. Grade 3 or 4 acute and late toxicity were present in 16 and 9 patients, respectively. The FIGO stage and the tumor size were predictors of severe late toxicity. CONCLUSION: The data clearly showed that a higher FIGO stage was correlated with a worse survival outcome and higher severe late toxicity. Therefore, precise RT and careful observation are crucial in advanced vaginal cancer. In this study, the HPV status was not related to the survival outcome, but its further investigation is needed.

Clinical analysis of patients underwent hysterectomy for stage Ⅰ cervical cancer or high grade ;cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia / 中华妇产科杂志

Objective To analyse the necessity of colposcopic directed biopsy to vaginal intraepithelial neoplasia (VAIN) before hysterectomy due to early stage cervical cancer (stage Ⅰ) or high grade cervical intraepithelial neoplasia (CIN). Methods A total of 669 patients who underwent a hysterectomy due to early stage cervical cancer (stage Ⅰ) and CINⅢin Beijing Obstetrics and Gynecology Hospital, Capital Medical University,from January 1, 2009 to December 31, 2013 and followed up, 99 patients with VAIN were enrolled. The clinical data and following up the prognosis were prospectively analyzed retrospectively. Results The occurrence rate of VAIN before and after hysterectomy due to cervical dysplasia was 14.8%(99/669), the occurrence rate and the grade of VAIN showed that significantly increased from CINⅢto cervical cancer stageⅠ(P<0.05);Only 15 patients enrolled had undergone vaginal wall biopsy by colposcopy pre-hysterectomy, including 11 patients who were diagnosed with VAINⅡ-Ⅲand underwent vagina extended resection during the hysterectomy. The 5 year recurrence rate of vaginal stump VAIN after hysterectomy was 12.1%(12/99) and the progression rate was 4.0%(4/99), the recurrent rate was 2.0%(2/99). Conclusions For all the patients who are planning to undergo hysterectomy due to stageⅠcervical cancer and CINⅢ, routine upper side of the vagina wall colposcopic-directed biopsy pre-hysterectomy is strongly recommended. All the patients after hysterectomy due to cervical dysplasia should be followed up regularly within 3 years after hysterectomy.

The correlation between vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia, and their risk factors / 中国医师杂志

Objective To investigate the correlation and risk factors between vaginal intraepithelial neoplasia (VAIN) and cervical intraepithelial neoplasia (CIN).Methods A total of 121 cases of VAIN patients was retrospectively analyzed with examination results such as clinical manifestations,liquid based cytology (TCT),human papilloma virus infection,virus infection type,and clinical data of treatment and follow up.Results VAIN Ⅰ,VAIN],and VAIN Ⅲ] were accounted for 33.9％ (41/121),38.0％ (46/121),and 24.4％ (34/121) ; for 40 or less years old patients,VAIN Ⅲ was accounted for 10.7％ (3/28) ; for more than 40 years old patients,VAIN Ⅲ was accounted for 33.3％ (31 /93).Among 121 VAIN patients,77.7％ (94/121) patients had CIN history,15.7％ of which (19/121) had a history of cervical cancer; 27.3％ (33/121) with hysterectomy history,of which 75.8％ (25/33) was due to cervical intraepithelial neoplasia and cervical cancer resection of the uterus.Papilloma viral load in patients with VAIN Ⅰ was detected with a (HPV-HC2) positive rate of 87.8％ (36/41),while in VAIN Ⅱ and VAIN [patients,the positive rate was 100％,the infection of high risk type of HPV ratio was 95.9％ (116/ 121).of which the mixed infection was accounted for 56.9％ (66/116).There was 94.6％ in oatients with VAIN (114/121),and liquid-based cytology test results suggest abnormality; 88.4％ (107/121) in patients with VAIN lesions occurred in upper 1/3 of vaginal.After diagnosed cervical disease,the onset time of VAIN was (3.45 ± 2.02) years,non-total-hysterectomy was (3.24 ± 1.97) years,after hysterectomy to pathological diagnosis time for VAIN was (5.01 ± 3.95) years:for the diagnosis of VAIN disease after resection of cervical original time was (3.96 ± 2.99) years,and rather than non cervical disease resection was an average of (9.94 ±5.37) years.In the course of treatment of the 12l cases of CIN patients,6 cases of patients were progressed to invasive carcinoma.Conclusions The clinical manifestation of VAIN is similar to CIN,the principle of diagnosis and treatment of CIN can also apply to VAIN,high risk HPV infection virus,cervical intraepithelial neoplasia are the risk factors for VAIN.

Opções terapêuticas na neoplasia intraepitelial vaginal: revisão de literatura / Therapeutic modalities for vaginal intraepitelial neoplasia: literature review

A neoplasia intraepitelial de vagina (NIVA) é uma condição pré-maligna rara do epitélio vaginal, sua incidência corresponde a 0,2 casos por 100.000 mulheres, classifica-se em NIVA I, II, III esta última tem um potencial de invasão de 9 a 12%. O diagnóstico é feito pela citologia, colposcopia, histopatologia. Todos os métodos terapêuticos tem uma taxa razoável de sucesso e a taxa de recorrência varia entre 10 e 42%. O tratamento pode ser: cirúrgico, ablativo, radioterápico, clínico e expectante. O excisional tem preferência por fornecer peça para análise histopatológica excluindo a doença invasiva apresentando as melhores taxas de sucesso entre 66% a 83% . A ablação é indicada quando a suspeita de invasão foi afastada e é a modalidade de eleição nas mulheres jovens, a eficácia varia entre 69 a 87%. A radiação tem uma taxa de sucesso entre 69 a 100%; porém, as complicações giram em torno de 36%. Pela sua praticidade o tratamento feito com os agentes tópicos tem ganhado espaço terapêutico na abordagem da NIVA. Não existe evidência científica quanto a melhor forma e o tempo de seguimento das mulheres com NIVA. Qualquer que seja a opção de tratamento utilizada um seguimento longo deve ser preconizado.(AU)

Vaginal intraepithelial neoplasia (VAIN) is an uncommon premalignant condition of the vaginal epithelium, its incidence is found to be 0.2 per 100.000 women, this condition is classificated in VAIN I, II and III, the lifetime risk of transformation to invasive carcinoma has been reported as 9 to 12%. The diagnosis was done by cytology, colposcopy and histology. All the therapeutics modalities have a successful cure rate and the recurrence ranges are between 10 to 42%. The treatment modalities are: excisional, ablative, radiotherapic, clinical and expectante. Excisional has preference as it could exclude invasion disease and has the best success rate, 66 to 83%. Ablation has preference in young women with no suspect of invasion, with efficacy ranging between 69 to 87%. The cure rate of radiotherapy is high as 69 to 100% but this modality has 36% morbidity rate. Treatment with topical agents constitutes a promising option in VAIN management. There is no scientific evidence of what kind follow-up is better. Whatever treatment modality is used long-term follow-up is essential.(AU)

High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. MATERIALS AND METHODS: We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. RESULTS: Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097). CONCLUSION: HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. MATERIALS AND METHODS: We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. RESULTS: Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097). CONCLUSION: HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

A Case of Vaginal Cancer with Uterine Prolapse

Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 x 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis.

Vaginal cancer with multiple liver and pulmonary metastases that achieved long-term survival

Primary vaginal cancer represents only 1% to 2% of malignant neoplasm of the female genital tract. Here, we report a 68-year-old woman who showed a vaginal tumor extending to urethra and clitoris, a 10 cm-sized mass in left adnexa and multiple metastases in lung and liver. Vaginal biopsy showed squamous cell carcinoma of vagina and she was diagnosed as International Federation of Gynecology and Obstetrics stage IVB vaginal cancer. Palliative surgery including left salpingectomy, tumorectomy, and clitoris mass excision was performed. Concurrent chemoradiation therapy (CCRT) with six cycles of 5-fluorouracil and cisplatin was administered. The patient had a complete remission of 20 months after treatment. At a 40-month follow-up, there was no evidence of local recurrence or distant metastasis. We can suggest that CCRT is very effective in treating primary squamous cell carcinoma of the vagina, not only in locally advanced but also systemically involved vaginal cancer in selected cases.

Primary leiomyosarcoma of the vagina: a clinical analysis of 9 cases / 中华妇产科杂志

Objective To analyze the clinical characteristics,diagnoses,treatments and prognoses of vaginal leiomyosarcoma (LMS).Methods The clinical and pathological recordings of 9 patients suffering from vaginal leiomyosarcoma from January 1973 to May 2011 were analyzed retrospectively.Results The study group constituted 2.7％ (9/330) of all the malignant vaginal tumor admitted to our hospital in the same period.The major clinical manifestations were asymptomatic vaginal mass (3/9),bellyache and vaginal bleeding (2/9),vaginal pain (2/9),and difficulty in defecation (1/9) and micturition (1/9).Preoperative diagnosis was highly unreliable.Based on the sample chose,the diagnosis were made in 3 cases by preliminary biopsy before undertaking surgery,while 6 cases were confirmed shortly after simple tumor excision or unexpected recurrence.All the patients were pathologically confirmed diagnosis by tumor resection specimen or biopsy,5 cases of them were also confirmed by virtue of immunohistochemistry staining.All 9 patients,8 cases received initial surgery,four of them patients received postoperative adjuvant chemotherapy or radiation therapy,the remaining 1 patients received initial chemotherapy and radiotherapy.Follow-up was performed for all the 9 patients,of which 3 cases were lost,the median follow-up time was 50 months (range 7-134).Four patients underwent local recurrence and adjacent organ metastases within two years,with 5 years survival rate 4/9.Conclusions Primary vaginal leiomyosarcoma is a rare and difficult to diagnose preoperatively tumor.In this regard,It is strongly recommend preoperative biopsy for definitive diagnosis and perform surgery as the principal approach,in conjunction with radiotherapy or chemotherapy when needed to improve survival.

Malignant Tumors of the Female Reproductive System

This review summarizes the epidemiology of cancer of the female reproductive system and associated lifestyle factors. It also assesses the available evidence for occupational factors associated with these cancers. Cervical, endometrial, and ovarian cancers are relatively common, and cause significant cancer morbidity and mortality worldwide, whereas vulvar, vaginal, fallopian tube cancers, and choriocarcinomas are very rare. As several lifestyle factors are known to play a major role in the etiology of these cancers, very few published studies have investigated possible relationships with occupational factors. Some occupational exposures have been associated with increased risks of these cancers, but apart from the available evidence on the relationships between asbestos fibers and ovarian cancer, and tetrachloroethylene and cervical cancer, the data is rather scarce. Given the multifactorial nature of cancers of the female reproductive system, it is of the utmost importance to conduct occupational studies that will gather detailed data on potential individual confounding factors, in particular reproductive history and other factors that influence the body's hormonal environment, together with information on socio-economic status and lifestyle factors, including physical activity from multiple sources. Studies on the mechanisms of carcinogenesis in the female reproductive organs are also needed in order to elucidate the possible role of chemical exposures in the development of these cancers.

Clinical analysis of 13 cases with vaginal intraepithelial neoplasia / 中华妇产科杂志

Objective To investigate the pathogenesis,high risk factors,clinical characteristics,methods of diagnosis and treatment,and prognosis of vaginal intraepithelial neoplasia (VAIN).Methods The clinical data of thirteen cases of VAIN treated in Zhejiang Provincial Cancer Hospital dated Mar.2002 through Dec.2008 were reviewed and analyzed retrospectively.Results Twelve of 13 VAIN cases were performed the human papillomavirus(HPV) detection with 92% (11/12) HPV positive rate.None of the cases shown specific clinical manifestation.Among the 13 cases,6 of them accompanied with cervical cancer,4 cases with cervical intraepithelial neoplasia (CIN ),and 3 cases with vulvar intraepithelial neoplasma (VIN).Five cases synchronously diagnosed with cervical lesion and 3 with vulva lesion were underwent surgery,while the other 5 cases were diagnosed metachronously.Among 8 cases underwent surgery,1 case with CIN underwent argon plasma coagulation (APC) after surgery,1 case with the positive edge of VIN underwent APC.During follow up,1 case with locally advanced cervical cancer underwent radiotherapy again,3 cases with VAIN received APC,while 1 cervical cancer cases with VAIN received no treatment.The average follow-up time was 25.6 months (range 6-87 months).Two cases died of cervical cancer metastasis.The other 11 cases were normal and still alive.None of them progressed to invasive carcinoma.Conclusions The main reason of VAIN is HPV infection.There are not specific clinical manifestations,usually diagnosed when reviewing cervical or vulva lesions and rarely progressed to invasive carcinoma.The main treatment of VAIN is surgery with the adjuvant treatment of APC.

Prognostic factors for primary vaginal carcinoma managed with radiotherapy : a study of 83 cases / 中华放射肿瘤学杂志

Objective To analyze the clinical and histopathologic characteristics and prognostic factors for primary carcinoma of the vagina managed with radiotherapy at a single institution . Methods Eighty-three patients with primary vaginal carcinoma were treated with definitive radiation therapy between 1980 and 2007 were retrospectively analyzed. Radiotherapy was delivered with external beam radiation alone in 11 patients, intracavitary after-loading radiation alone in 7 patients, and external beam combined with After-loading radiation in 65 patients. The median radiation dose was 75 Gy. Fifty-one patients received more than 75 Gy. Thirty-one patients received combined chemotherapy. Of them, 16 received intravenous neoadjuvant or adjuvant chemotherapy, 8 received intra-arterial chemotherapy and 7 received concomitant chemotherapy. Patients were staged acoording to FIGO staging system. Nineteen patients had stage Ⅰ ;31 had stage Ⅱ, 25 had stage Ⅲ and 8 had stage Ⅳ diseases. Fifty-three patients had squamous cell carcinoma, 22 had adenocarcinoma, 2 had adenosquamous cell carcinoma,3 had papillary serous carcinoma,2 had clear-cell carcinoma and 1 had undifferentiated carcinoma. Thirty-nine patients had grade 1 and 44 had grade 2 and/or grade 3 diseases. Results The follow-up rate was 89%. Thirty-five and 31 patients had minimum followed-up time of 3 and 5 years respectively. The 3-and 5-year overall survival rates were 51% and 42% respectively. Univariate analysis showed that FIGO stage ( x2 = 11.30,P= 0. 010), histopathology type (x2=5.76,P=0.016),pathologic grade (x2=5.76,P=0.016), tumor size (x2=4.81,P=0. 020), tumor site ( x2=23.50,P =0. 000), external beam combined with intracavitary irradiation ( x2 =29. 76,P =0. 000) correlated with overall survival rate. Cox multivariate analysis showed only FIGO stage ( x2 = 5.93, P = 0. 015 ) and tumor size ( x2 = 8.48, P= 0. 004 ) were independent prognostic factors affecting overall survival. Serious complications were developed in 12% ( 10/83 ) of the patients. One patient suffered from vesicovaginal fistula and 3 from rectovaginal fistula. Twenty-eight patients had local or distant relapses, and the 3-year overall survival rate was 14% after salvage therapy. Conclusions Radiotherapy is effective for early stage primary vaginal carcinoma. FIGO stage and tumor size were independent prognostic factors affecting overall survival. The role of chemotherapy for advanced disease needs further study.

Spindle Cell Epithelioma, a So-called Benign Mixed Tumor of the Vagina: A Case Report

We report a case of spindle cell epithelioma, a so-called benign mixed tumor of the vagina. The patient was a 35-year-old nulliparous woman who presented with a polypoid mass in the posterior wall of the lower vagina just above the hymenal ring. The tumor was relatively well-defined with an expansile margin and composed of stromal-type spindle cells with a myxoid stroma arranged in short fascicles and an irregular cord-like or reticular pattern. A few glandular structures lined by cuboidal cells with squamous metaplasia were also noted. Cellular atypia was not conspicuous and mitosis was not found. We examined this tumor immunohistochemically to identify the histogenesis. The coexpression of epithelial and mesenchymal markers in stromal-type spindle cells suggested a multipotential cell origin for this tumor. The patient has been well with no signs of recurrence during the 12 months after surgery.