Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

ABSTRACT Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder. Materials and Methods: From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence. Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence. Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management. Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.

Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN

We present a case report of secondary vaginal cancer after complete hysterectomy due to myoma that was complicated by low-grade cervical intraepithelial neoplasia [CIN I] and human papilloma virus [HPV] infection. After complete hysterectomy, the HPV DNA level in the vaginal tissue was obviously increased, and vaginal cancer was diagnosed 6 months later. We conclude that HPV infection can cause vaginal cancer after complete hysterectomy in cases complicated by CIN. Therefore, HPV should be regularly assessed during the postoperative follow-up period

Cáncer primario de vagina / Vaginal primary cancer

El carcinoma primario de vagina es una neoplasia poco frecuente, representando solamente el 1-2 por ciento de todos los tumores malignos del área ginecológica. Según la FIGO solo se considera como cáncer primario de vagina a aquellas lesiones confinadas a la vagina sin invasión del cuello uterino o la vulva. El pronóstico depende principalmente del estadio en que se encuentra la enfermedad, pero la supervivencia se reduce en pacientes mayores de 60 años de edad, si son sintomáticos al momento del diagnóstico, tienen lesiones del centro y tercio inferior de la vagina o tienen tumores mal diferenciados. Los objetivos de este estudio fueron evaluar la experiencia en el manejo del cáncer primario de vagina, identificar variables demográficas y clínicas, mostrar la variedad histológica de presentación de esta neoplasia tan rara, así como el grado de diferenciación en cada caso. Igualmente relacionar estadio del cáncer, tratamiento y respuesta en cada una de las pacientes. Se trata de un estudio retrospectivo de cinco pacientes con cáncer primario de vagina atendidas en el Servicio de Patología de cuello del Hospital Ramón González Coro, durante el año 2008. La evaluación inicial consistió en una historia clínica completa, examen físico haciendo hincapié en el área ginecológica descartando lesiones en vulva o cuello uterino. A todas las pacientes se les realizó biopsia excisional del tumor, enviando la muestra al estudio histopatológico. Se les realizó cistoscopia, rectoscopia, urograma descendente, a aquellas pacientes con sospecha de infiltración de vejiga o recto, laboratorio, radiografía del tórax y se estadiaron según la clasificación de la FIGO

The primary vaginal carcinoma is a uncommon neoplasm present only in the 1-2 percent of all the malignant tumors of gynecology area. According to International Federation of Gynecology and Obstetrics only is considered as a primary vaginal cancer of those lesions confined to vagina without invasion of cervix or the vulva. The prognosis depends mainly on the disease stage, but the survival is reduced in patients aged over 60 if they are symptomatic at diagnosis, have lesions of the center and the inferior third of vagina or have ill-differentiated. The objectives of present study were to assess the experience in the vaginal primary cancer management, to identify demographic and clinical variables, to show the histological variety of presentation of this so rare neoplasm, as well as the differentiation grade of each case and to relate the cancer stage, the treatment and the response of each patient. It is retrospective study conducted in 5 patients presenting vaginal primary cancer seen in the Cervix Pathology Service of the am Ramon González Coro Gynecology and Obstetrics Hospital during 2008. The initial assessment included a complete medical record, physical examination with emphasis in the gynecological area ruling out vulva or cervix uteri lesions. All patients underwent excision biopsy of tumor with the corresponding histopathological study of the sample. A cystoscopy, rectoscopy descending urogram were carried out in those patients with a possible bladder or rectum infiltration, lab tests, thorax Rx staged according the International Federation of Gynecology and Obstetrics classification

Leiomiosarcoma uterino con metástasis vaginal / Metastatic uterine leiomyosarcoma vaginal

Se presenta una paciente femenina de 37 años de edad, con metrorragia y sensación de peso abdominal, sin cambios defecatorios. La ecografía abdominal y transvaginal mostraron útero aumentado de tamaño. La biopsia quirúrgica del cérvix y fórnix vaginales, respetando las paredes vaginales, diagnosticaron metástasis de leiomiosarcoma uterino. El leiomiosarcoma representa un tumor raro de útero, usualmente diagnosticado en forma errónea como leiomioma. Se debe sospechar ante un agrandamiento difuso del útero, con evolución rápida en su crecimiento, cambios significativos en la clínica y metástasis a distancia. Los signos en resonancia magnética son variables y muchas veces similares a los de los leiomiomas degenerados. La combinación de RM dinámica con GpTPA y niveles séricos de LDH aumentan la especificidad, valor predictivo positivo, valor predicativo negativo y precisión diagnóstica del método.

Carcinoma primário de vagina / Primary carcinoma of vagina

Os autores apresentam um caso de carcinoma escamoso in situ de vagina, tido como primário deste órgäo por obedecer aos critérios da Figo onde a ectocérvice apresenta-se íntegra, näo há metástases clinicamente detectáveis, sem antecedentes de NIC ou verrugas genitais. A endocérvice e a vulva também näo evidenciaram anormalidades epiteliais através de microcolpohisteroscopia realizados

Melanoma vulvo vaginal / Vulvar and vaginal melanoma

Los melanomas de mucosas son raros de observar. El melanoma de vulva representa entre un 8-11 por ciento de los cánceres con esa localización. Presentamos una mujer de 72 años con una lesión pigmentada de bordes irregulares, con proyección a vagina, midiendo en su diámetro mayor 3-4 cm. Se realiza una biopsia que permite el diagnóstico de melanoma maligno. Se realiza tratamiento quirúrgico: vulvectomía total y colpectomía parcial. El informe histopatológico refiere: clítoris: melanoma lentiginoso nivel IV de Clark con espesor de 1 cm. En cara anterior de vagina, el informe es similar. El diagnóstico de melanoma genital suele realizarse tardíamente por la frecuente imposibilidad de observación de la lesión por parte del paciente. El pronóstico del melanoma vulvo vaginal es malo. La sobrevida a los 5 años varía entre el 20 por ciento y 50 por ciento

Case of pelvic relapse in a child suffering from acute lymphoblastic leukemia

We describe here a case of an eight years old child suffering from acute lymphoblastic leukemia. She developed pelvic infiltration of leukemic cells while in bone marrow remission and receiving maintenance chemotherapy. She also developed leukemic infiltration of Central Nervous System and died of complications resulting from massive pelvic relapse. With greater number of children in bone marrow and CNS remission, the issue of possible greater predisposition to extramedullary replase has been discussed. The need for greater vigilance towards pelvic surveillance has been stressed

Hemangioma vaginal en la infancia: presentación de caso clínico / Vaginal hemangioma in childhood: presentation of clinical case

La genitorragia en la infancia puede llegar a ser un problema diagnóstico si no se enfrenta apropiadamente. El objetivo de esta comunicación es presentar un caso clínico de una paciente con genitorragia a repetición cuyo diagnóstico final fue un hemangioma vaginal

Consideraçöes sobre as lesöes precursoras do câncer da vagina / Vaginal precancerous lesions

Säo tecidas consideraçöes sobre as lesöes precursoras dos dois carcinomas mais freqüentes da vagina: o denocarcinoma de células e o carcinoma epidermóide. Ressalta-se a adenose de vagina e sua provável relaçäo, em pequena porcentagem de casos, com o adenocarcinoma de células claras, em mulheres expostas intra-útero ao dietilestilbestrol. A seguir, descarta-se como precursora do carcinoma espinocelular a maioria das condiçöes já estudadas neste sentido. Säo referidas recentes publicaçöes que demonstram o aparecimento de neoplasias intra-epiteliais da vagina do tipo escamoso em focos de adenose vaginal. Por fim, levanta-se a hipótese de que as rara glândulas presentes na vagina de uma minoria de mulheres näo expostas intra-útero poderiám ser, em nosso meio, a lesäo precursora do carcinoma epidermóide de vagina