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.

Rabdomiosarcoma botrioide del aparato genital femenino en una adolescente virgen / Botryoid Rhabdomyosarcoma of the Female Genital Tract in a Virgin Adolescent

El rabdomiosarcoma es un tumor complejo y de gran malignidad que se origina en las células de la mesénquima embrionaria con capacidad para diferenciarse en células musculares esqueléticas. Este es el tumor maligno de tejido blando más frecuente. Representa aproximadamente 3,5 por ciento de los casos de cáncer en niños de 0 a 14 años de edad. Se presenta una paciente adolescente y virgen en la que se diagnostica histológicamente rabdomiosarcoma botrioide de la vagina. La presentación clínica del rabdomiosarcoma embrionario variedad botrioide es, en general, una masa que protruye por la uretra o el introito vaginal, o por la presencia de flujo fétido o sangrado vaginal en niñas menores de 2 años. En estas lesiones el apoyo diagnóstico con inmunohistoquímica es de vital importancia. El pronóstico de esta enfermedad está determinado por variables como el tamaño tumoral, órgano comprometido, edad del paciente, resultado quirúrgico (R0/R1) y presencia de metástasis. La evaluación médica multidisciplinaria precoz y oportuna permitirá siempre establecer un diagnóstico y tratamiento adecuados(AU)

Rhabdomyosarcoma is a complex and highly malignant tumor that originates in the cells of the embryonic mesenchyme with the ability to differentiate into skeletal muscle cells. This is the most common malignant soft tissue tumor. It represents approximately 3.5 percent of cancer cases in children from zero to 14 years of age. A case of a virgin adolescent patient is presented. A botryoid rhabdomyosarcoma of the vagina was diagnosed histologically. The clinical presentation of embryonic botryoid rhabdomyosarcoma variety is, in general, a mass that protrudes through the urethra or vaginal introitus, or the presence of fetid flow or vaginal bleeding in girls under 2 years. In these lesions, diagnostic support with immunohistochemistry is of vital importance. The prognosis of this disease is determined by variables such as tumor size, compromised organ, age of the patient, surgical result (R0 / R1) and presence of metastasis. Early and timely multidisciplinary medical evaluation will always allow an adequate diagnosis and treatment to be established(AU)

Carcinoma neuroendocrino primario de vagina. Revisión de literatura a propósito de un caso / Primary neuroendocrine carcinoma of the vagina. Literature review on the subject of a case

RESUMEN El carcinoma primario de vagina representa 1 a 2% de los cánceres ginecológicos, siendo la diferenciación histológica neuroendocrina de células pequeñas extremadamente infrecuente, sólo se han reportado 28 casos en la literatura, describiéndose en orden de frecuencia en cérvix, endometrio, ovario, vagina y vulva. Se observa con más frecuencia en mujeres postmenopáusicas. Se presenta el caso de paciente femenino, de 39 años de edad, quien acude a la consulta por presentar secreción genital serohemática, fétida, de 1 mes de evolución, evidenciándose al examen físico lesión exofítica, friable, renitente, de aproximadamente 4 cm de diámetro, en tercio superior y cara posterolateral izquierda de vagina, por lo que se realiza biopsia excisional de dicha lesión, siendo el diagnóstico anatomopatológico carcinoma neuroendocrino de células pequeñas, grado histológico: 3. A propósito de este caso, se realiza una revisión del tema, haciendo hincapié en la importancia de la exploración ginecológica exhaustiva que incluya tomas de citologías y colposcopias periódicas, tomando en cuenta la vagina y así, realizar diagnóstico precoz en vista que el riesgo de carcinoma en dicha zona es infrecuente, mejorando el pronóstico y sobrevida de las pacientes.

ABSTRACT The primary carcinoma of the vagina represents 1 to 2 % of gynecologic cancers, being the histological differentiation neuroendocrine of small cells extremely infrequent, only 28 cases have been reported in the literature, describing in order of frequency: in the cervix, endometrium, ovary, vagina and vulva. It is most commonly seen in postmenopausal women. We present the case of a female patient, 39 years old, who comes to medical consult due to serohematic, fetid, genital discharge of 1 month of evolution, evidencing at physical examination an exophytic lesion, friable, renitent, with a diameter of approximately 4 cm, in the upper third and posterolateral left side of the vagina, for which an excisional biopsy of said lesion is performed, being the anatomopathological diagnosis neuroendocrine carcinoma of small cells, histological grade: 3. A bibliography reviewed was made, emphasizing the importance of exhaustive gynecological exploration with periodic cytology and colposcopy examinations, including the vagina for early diagnosis in view of carcinoma risk in this area is uncommon, improving the prognosis and survival of patients.

When an unexpected diagnosis occurs: a vaginal premenopausal sarcoma / Quando um diagnóstico inesperado ocorre: um sarcoma vaginal na pré-menopausa

Abstract Vaginal cancer is a rare entity. The evidence on its management resides mostly in clinical cases or small case series. Of the histological types, the most frequent is the squamous cell carcinoma, followed by adenocarcinoma. But what to do when identifying an even more infrequent sarcoma in a premenopausal woman? In this study, we describe the case of a 53-year-old woman presenting with metrorrhagia for two months, who was evaluated after an intense episode. A necrotic and ulcerative vaginal swelling was documented and then submitted to biopsy, which revealed a vaginal sarcoma. The patient was referred to radiation therapy with 50 Gy (aiming to control the symptoms and to cause tumor reduction for posterior pelvic exenteration with intraoperative radiotherapy) and developed an extra-pelvic metastization at the end of the treatment, which caused a fast negative outcome. Despite the initial poor prognosis, a chemo-irradiation or primary surgery regimen might have achieved (although with greater side effects) a better survival. This case-report entails a discussion about the strategies to manage vaginal sarcoma in advanced stage and in premenopausal women.

Resumo O cancro vaginal é uma doença rara. A evidência para a sua abordagem reside fundamentalmente em casos clínicos ou pequenas séries de casos. Dentre os tipos de cancro histológicos, o mais frequente é o carcinoma espinocelular, seguido do adenocarcinoma. Mas o que fazer em presença de um sarcoma ainda mais raro numa mulher pré-menopáusica? No presente estudo, descrevemos o caso de uma mulher de 53 anos apresentando metrorragia por dois meses, avaliada após um episódio intenso. Foi então documentada uma tumefacção vaginal necrótica e ulcerativa, submetida a biópsia, que revelou um sarcoma vaginal. A paciente foi encaminhada para radioterapia com50 Gy (comos objetivos de controlo da sintomatologia e de redução tumoral para posterior exenteração pélvica com radioterapia intraoperatória) e desenvolveu, ao final do tratamento, umquadro demestastização extra pélvica, que ocasionou um desfecho negativo rápido. Apesar do mau prognóstico inicial, um esquema de quimiorradiação ou cirurgia primária poderiam ter alcançado (ainda que com maiores efeitos laterais) uma maior sobrevivência. Este estudo de caso aborda uma discussão sobre as estratégias de abordagem do sarcoma vaginal em estádios avançados e na mulher pré-menopáusica.

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)

Linfoma no Hodgkin primario de vagina / Primary non Hodgkin's lymphoma of the vagina

La afectación primaria del tracto genital femenino de los linfomas no Hodgkin es poco frecuente (2 por ciento de los linfomas primarios extraganglionares). Los órganos más afectados son los ovarios seguidos del cérvix, siendo la localización endometrial y vaginal extremadamente rara. Presentamos el caso de una paciente de 44 años diagnosticada de linfoma primario de vagina, estadio IE A, con remisión completa tras tratamiento combinado quimioterápico y quirúrgico. Es importante tener presente estas raras aunque posibles localizaciones de linfomas para evitar que se puedan confundir con lesiones inflamatorias u otros tipos de tumores que nos lleven a un fracaso terapéutico.

Primary non-Hodgkin lymphomas rarely involve the female genital tract (2 percent of primary extranodal lym-phomas). The ovaries followed by the cervix are the most common affected sites while the involvement of the endometrium and vagina is extremely rare. We report the case of a 44 year old woman with a primary lymphoma of the vagina, stage IE A, with complete remission after combined chemotherapy and surgical treatment. These rare but possible locations must be kept in mind to avoid misdiagnosis with inflammatory lesions or other types of tumors which may lead us to a therapeutic failure.

Neoplasia vaginal intraepitelial / Vaginal intraepithelial neoplasia

Objetivo: actualizar los conocimientos disponibles sobre la neoplasia vaginal intraepitelial (VAIN) especialmente en el diagnóstico y tratamiento. Métodos: revisión de la literatura en Pubmed de los últimos 20 años, especialmente de los publicados desde 2005 hasta la actualidad y considerando sobre todo los ensayos clínicos aleatorizados. Resultados: su prevalencia real es desconocida, aunque es una patología rara generalmente en mujeres posmenopaúsicas. Su fisiopatología es similar a la neoplasia cervical intraepitelial, con el HPV como principal factor de riesgo, sobre todo el serotipo 16, pero su progresión a cáncer es menor. Un grupo importante es el de VAIN tras histerectomía, que supone el 48-70 por ciento del total de las VAIN. La colposcopia para el diagnóstico no es sencilla y se aconseja preparación con estrógenos en las pacientes menopáusicas y utilización de ácido acético y lugol para identificar las zonas sospechosas. Las tres opciones terapéuticas son la cirugía (excisional, láser, ultrasonidos), braquiterapia y tratamiento médico (imiquimod, 5-fluorouracilo, ácido tricloroacético). Se expone la técnica y las ventajas e inconvenientes de cada uno de ellos. Conclusión: aunque la VAIN es una entidad rara, es preciso tenerla en cuenta ante un diagnóstico de lesión citológica. Su diagnóstico a veces no es sencillo y el tratamiento dependerá del grado, la localización y el tamaño de la lesión y las circunstancias personales de la paciente. Se necesitan más ensayos aleatorizados que comparen la eficacia entre las distintas opciones terapéuticas y su repercusión en la calidad de vida de las pacientes.

Aims: update the knowledge about vaginal intraepithelial neoplasia (VAIN) with special emphasis on diagnosis and therapeutic management. Method: electronic search of Pubmed of all kinds of articles about the VAIN, for the last 20 years with special attention to those published from 2005 to the present and considering especially randomized clinical trials. Results: its prevalence is unknown, although it is a rare condition that usually occurs in postmenopausal women. The physiopathology is similar to cervical intraepithelial neoplasia, being HPV the main risk factor, particularly serotype 16, but its progression to cancer is lower. An important group is VAIN after hysterectomy, 48-70 percent of total VaIN. Colposcopy for the diagnosis is not easy and in patients with postmenopausal the preparation with local estrogen is necessary and use both of acetic acid and lugol to identify suspicious areas. The three treatment options are surgery (excisional, laser, ultrasound), brachytherapy and medical management (imiquimod, 5-fluorouracil, tricholoroacetic acid). The technique and the advantages and disadvantages of each are explained. Conclusion: although VAIN is rare, it must take it into account before a cytological diagnosis of dysplasia. Its diagnosis is sometimes not easy and the treatment depends on the extent, location and size of the lesion and the individual preferences of the patient. We need more randomized trials comparing different treatment options and also their impact on quality of life of patients.

Mioepitelioma de vagina: neoplasia poco frecuente en esta localización, reporte de un caso / Myoepithelioma located in the vagina of a pregnant woman

Antecedentes: Los mioepiteliomas, son tumores poco frecuentes originados a partir de la proliferación de células mioepiteliales. La mayor parte localizados en las extremidades inferiores y en glándulas salivales. Existen ocasionales informes previos de MEP que involucren la vagina. Objetivo: Describir un caso de mioepitelioma localizado en vagina. Caso clínico: Embarazada de 29 años edad, quien presenta una masa vaginal de un año de evolución, localizada en el himen. El examen histopatológico muestra una lesión compuesta por células fusiformes con positividad inmunohistoquímica para vimentina, citoqueratinas (CK) AE1/ AE3, S100, CD10, receptores de estrógenos y progesterona, Bcl2 y calponina y negatividad para desmina, actina muscular especifica, actina de músculo liso y p63. Con los anteriores hallazgos se interpreta la lesión como un mioepitelioma primario vaginal. Conclusión: Los mioepiteliomas son tumores que requieren para su diagnostico, análisis con técnicas de inmunohistoquímica o ultraestructurales que permitan diferenciarlos de otros tumores.

Background: The myoepitheliomas are rare tumors arising from the proliferation of myoepithelial cells. Most tumors are located in the lower extremity and salivary glands. There have been only occasional myoepithelial neoplasms previously reported involving the vagina. Objective: Describe a case of myoepithelioma located in the vagina of a pregnant woman. Case report: A 29 years old pregnant female, who about 1 year prior has a vaginal mass, located in the hymen. At histopathological examination shows a mass composed of spindle cells with positivity immunohistochemical studies for vimentin, cytokeratin AE1/AE3, S100, CD10 and calponin and negative for desmin, actinmuscle specific (HHF35), smooth muscle actin and p63. With these findings it was established the diagnosis of myoepithelioma in the vagina. Conclusion: Myoepitheliomas are tumors requiring for diagnostic of immunohistochemistry or ultrastructural techniques that allow its differentiation from other tumors.

Melanosis of the vagina and human papillomavirus infection, an uncommon pathology: Case Report / Melanosis de la vagina e infección por virus del papiloma humano, una patología poco común: Reporte de un Caso

Benign melanotic lesions of the vagina are uncommon and only a few cases have been reported in the literature. A 34-year-old woman was referred because of a Vaginal Intraepithelial Neoplasia 1 biopsy result. On the gynecological examination, two different hyperpigmented areas were noted in the vagina. The colposcopic visualization of the cervix and vagina found an aceto-white lesion at the right lateral wall of the upper third of the vagina. Biopsies from three areas were taken. Histological study reported a melanosis of the vagina and HPV infection. An immunohistochemical panel of epithelial markers was performed in vaginal samples, such as Cytokeratin AE1/AE3 and epithelial membrane antigen, mesenchymal marker: vimentin; melanocytic makers: protein S-100 and HMB45 (Human Melanoma Black); proliferating cell marker: proliferating cell nuclear antigen (PCNA), and P-53 oncoprotein. High Risk (16, 18, 31, 45) and Low Risk (6, 11) HPV types were studied by In Situ Hybridization using the same vaginal samples. CK, EMA and Vimentin were 2+. Melanocytic markers, HMB45 and S100, and PCNA were 1+ in basal cell layer. P-53 was negative. The melanotic tissue and acetowhite lesion were positives to HPV Types 6,11. In conclusion, melanosis of the vagina is a uncommon benign pathology. Usually, melanosis is present in women over 40 years old. We present a case of melanosis of the vagina in a young woman infected with low-risk HPV types and review the literature.

Las lesiones melanóticas de la vagina son infrecuentes. y Solo pocos casos han sido reportados. Se presenta el caso de una mujer de 34 años quien es referida con diagnóstico de una Neoplasia Intraepitelial Vaginal 1. Al examen ginecológico, se encontraron dos áreas hiperpigmentadas en la vagina. La exploración colposcópica del cuello uterino y vagina reveló la presencia de una lesión aceto-blanca en la pared lateral derecha del tercio superior de la vagina. Muestras de biopsias fueron tomadas en dichas áreas. El estudio histológico reportó una melanosis de la vagina y una infección por el virus del Papiloma Humano (VPH). Se realizó un panel de estudio inmunohistoquímico de marcadores epiteliales en las muestras vaginales: tales como citoqueratina AE1/AE3 y antígeno epitelial de membrana; marcador mesenquimal: vimentin; marcadores melanóticos: proteina S-100 y HMB45 (Human Melanoma Black); marcadores de proliferación celular: antígeno de proliferación nuclear (PCNA), y la oncoproteína P-53. Se realizó Hibridización In Situ para establecer los tipos de alto (16, 18, 31, 45) y bajo (6, 11) riesgo de VPH en las muestras vaginales. Los marcadores CK, EMA y Vimentin fueron 2+. Los marcadores melanótico, el HMB45 y el S100, y el PCNA fueron 1+ en la capa basal. P-53 fue negativo. El tejido melanótico y la lesión acetoblanca fueron positivos al VPH 6,11. En conclusión, la melanosis vaginal es una patología poco frecuente. Usualmente, se ha reportado en mujeres mayores de 40 años. Presentamos un caso de una melanosis de la vagina infectada con un tipo de VPH de bajo riesgo en una mujer joven y una revisión de la literatura.

Mioma vaginal: reporte de un caso / Vaginal myoma: case report

Presentar un caso de mioma vaginal en una mujer de 52 años. Paciente asintomática, que acude a la consulta para control ginecológico. Se detecta una lesión en cara posterior de vaginal, sobre elevada e hiperpigmentada de aproximadamente 1 cm de diámetro, la cual fue extirpada con asa diatérmica; se envió el material para estudio histopatológico y el resultado fue leiomioma en vagina con hiperpigmentación melánica en la capa basal del epitelio. La paciente evolucionó bien

Vaginal myomas are very rare, generally asymptomatics, but could be presented with diverse symptoms regarding their localization and do not differ from their uterine counterparts. We present a clinic case of a 52 years old woman, asymptomatic, in whom a 1 cm sobreelevated, hyperpigmentated lesion was found on the posterior vaginal wall, which was removed with diathermical loop excision. Her pathological result was vaginal leiomyoma with melanical hyperpigmentation of the basal layer of the epithelium. We also present a literature revision

Endometrioid Adenocarcinoma in Urethrovaginal Septum: A Diagnostic Pitfall

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.

Angiomyofibroblastoma of the vagina.

In 2006, a 36-year-old Burmese woman presented with prolonged vaginal bleeding. She had undergone pelvic examination that disclosed pedunculated polypoid vaginal mass. It originated from the posterior vaginal wall. Local excision was done, resulting in good condition. Pathological diagnosis was angiomyofibroblastoma. Angiomyofibroblastoma is a rare, benign non-recurring lesion, mesenchymal tumor occurring mainly in the vulval region of premenopausal women and local excision with clear margins is an adequate treatment.

Villous adenoma: a rare tumor of vaginal vault.

Villous adenomas are extremely rare tumors in the vagina and are indistinguishable from their colonic counterparts. These are considered as enteric type neoplasms of lower female genital tract arising from cloacal remnants. The significance of this lesion lies in the fact that it has to be distinguished from metastatic adenocarcinoma from other sites. We present a case of villous adenoma of vaginal vault, a rare site of presentation in a 30-year-old female.

Primary malignant melanoma of vagina--a case report with review of literature.

Primary vaginal malignant melanoma is a very rare tumor with less than 300 cases reported to date. We describe a case of primary vaginal melanoma and review the literature. A 60 years postmenopausal female patient presented with painless mass coming out of the vagina with occasional bleeding for last 2-3 weeks. On vaginal examination there was a firm polypoidal growth of size 7 cm attached to the right lateral wall of vagina and coming out of the introitus. Histopathology of the mass showed features of malignant melanoma. Wide local excision was done and adjuvant therapy was given. However patient came back after three months with widespread metastasis and expired 6 months after the initial diagnosis. Vaginal melanoma is a very aggressive tumor and the overall prognosis is very poor despite the treatment modality.

Angiomyofibroblastoma Arising from the Posterior Perivesical Space: a Case Report with MR Findings

Angiomyofibroblastoma is a rare benign soft tissue neoplasm that predominantly occurs in the genital region of middle-aged women. We present a case of an angiomyofibroblastoma that involved the posterior perivesical space in a 48-year-old woman. We have documented the magnetic resonance imaging features of this case.

Aggressive vaginal angiomyxoma mimicking urethral tumor

This is a case report of a 32-year-old female patient with a neoplasia mimicking a urethral tumor. Following anterior pelvic exanteration, vulvectomy, bilateral inguinal lymphadenectomy, the pathological study established the diagnosis of aggressive vaginal angiomyxoma, CD-34 labeled.

Vaginal endodermal sinus tumor.

Malignant germ cell tumors are rare tumors of childhood accounting less than 3% of pediatric malignancies, and endodermal sinus tumor (EST) is the most common histological subtype. The vagina is an extremely rare site for germ cell tumors (GCT). A one-year female was admitted with history of bleeding per vagina. She had pallor and a mass was palpable anteriorly on rectal examination. Magnetic Resonance Imaging (MRI) showed a tumor mass at the junction of cervix and vagina and biopsy was suggestive of a vaginal EST. The serum alpha fetoprotein (AFP) was elevated. She underwent vaginohysterectomy. The tumor was excised in toto and patient received four courses of cisplatin, etoposide and bleomycin. At one year of follow up, patient was symptom free and serum AFP remained at normal level. EST of the vagina is a rare, highly malignant GCT that exclusively involves children less than 3 years of age. It is both locally aggressive and capable of metastasis. Even though more conservative surgery is advised to maintain sexual and reproductive function, at times, radical surgery is mandatory depending on the infiltration of the tumor to the surrounding structures. Simple tumor excision is not sufficient, as residual cells induce recurrence and make chemotherapy ineffective. The serum AFP level is a useful marker for diagnosis and monitoring the recurrence of vaginal EST in infants.

Botryoid rhabdomyosarcoma of vagina--two case reports.

Botryoid rhabdomyosarcoma, previously considered a type of embryonal rhabdomyosarcoma, has clinicopathological features distinctive enough to warrant its classification as a separate entity. It almost always occurs in children under 5 years of age. Two cases of botryoid rhabdomyosarcoma are reported here because of their relative rarity.