ABSTRACT
Up to now, a vaginal well-differentiated neuroendocrine tumor (NET) has never been well described in the literature. A 2-cm vaginal nodule morphologically revealed a proliferation of mild to moderately atypical eosinophilic epithelioid cells, without tumor cell necrosis. Immunohistochemistry (IHC) showed positivity for CK (AE1/AE3), chromogranin A, and synaptophysin, focal positivity for CDX2, and negativity for PAX8 and TTF1. Metastatic origin was excluded by imaging and the morphological context with benign mucinous glands as present in the surgical resection specimen. Considering mitotic index and Mib1/Ki67 (8 mitoses/2 mm2; >20%), the case was diagnosed as vaginal NET G2 in the light of the WHO 2020 grading system for the gynecologic neuroendocrine neoplasms (NENs). Ranges of Mib1-Ki67 are not yet standardized. Currently, mitotic index and tumor cell necrosis were taken into consideration for the grading system. Gynecologic NENs still represent a diagnostic challenge. A clinico-radiologic workup and an appropriate diagnostic path ruling out the metastatic nature are mandatory to achieve the diagnosis.
Subject(s)
Neoplasm Grading , Neuroendocrine Tumors , Vaginal Neoplasms , Biomarkers, Tumor , Female , Humans , Ki-67 Antigen , Necrosis , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/pathology , Vagina/pathology , Vaginal Neoplasms/diagnosis , Vaginal Neoplasms/pathology , World Health OrganizationABSTRACT
BACKGROUND: Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. CASE REPORT: A gravida 2 para 0 46-year-old woman presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven to be effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or Magnetic Resonance Imaging (MRI) findings have not been described in English literature previously. CONCLUSION: Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.
Subject(s)
Vaginal Diseases , Diethylstilbestrol , Female , Humans , Magnetic Resonance Imaging , Metaplasia/pathology , Middle Aged , Vagina/diagnostic imaging , Vagina/pathology , Vaginal Diseases/diagnostic imaging , Vaginal Diseases/pathologyABSTRACT
We report a rare case of a 40 years old woman with primary vaginal clear cell adenocarcinoma (CCA) accompanied by Herlyn-Werner-Wunderlich syndrome (HWWS) and without any prenatal diethylstilbestrol exposure. Pathological results indicated that the CCA was surrounded by adenosis and that there was a benign to malignant transformation of several glands in the epithelium, so the CCA was believed to have arisen from the adenosis. The literature review disclosed that genitourinary anomalies might be associated with an increased risk of adenocarcinoma, but the mechanism was not clear.
ABSTRACT
BACKGROUND: We report an extremely rare case of vaginal clear cell carcinoma, which originated from the malignant transformation of vaginal adenosis without prenatal diethylstilbestrol (DES) exposure. CASE PRESENTATION: In this case, the patient was a Chinese woman with a history of two decades of intermittent vaginal pain, sexual intercourse pain and vaginal contact bleeding. On September 1, 2011, when the patient was 39 years old, a vaginal biopsy revealed vaginal adenosis. After intermittent drug and laser treatment, her symptoms did not improve. Four years later, on March 4, 2015, another vaginal biopsy for abnormal vaginal cytology revealed atypical vaginal adenosis. After treatment with sirolimus, her symptoms and abnormal vaginal cytology results persisted, and she underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and excision of the vaginal lesions. One year after the hysterectomy, on August 15, 2017, the vaginal cytology results suggested atypical glandular cells, and a biopsy revealed vaginal clear cell carcinoma originating from the atypical vaginal adenosis. A wide local resection of the vaginal lesions was performed, followed by concurrent chemoradiotherapy. Regular follow-up over 16 months showed no evidence of the recurrence of vaginal adenosis or cancer. CONCLUSIONS: Based on the evolution of a series of pathological evidence, we report the fourth case in the world of vaginal clear cell carcinoma originating from vaginal adenosis without prenatal DES exposure. Wide local excision with radiotherapy provided at least 16 months of disease-free survival.
Subject(s)
Adenocarcinoma, Clear Cell/diagnosis , Adenocarcinoma, Clear Cell/etiology , Carcinogens , Cell Transformation, Neoplastic , Diethylstilbestrol/adverse effects , Vaginal Neoplasms/diagnosis , Vaginal Neoplasms/etiology , Adenocarcinoma, Clear Cell/therapy , Adult , Biopsy , Combined Modality Therapy , Female , Humans , Treatment Outcome , Vaginal Neoplasms/therapyABSTRACT
We report a case of vaginal adenosis in a woman of 42years. This is a rare congenital disorder since cessation of use of diethylstilbestrol (DES), usually of benign course, not to ignore in its tubo-endometrial histological form which may progress to atypical adenosis precursor of vaginal clear cell adenocarcinoma in patients exposed in utero to DES.
Subject(s)
Exocrine Glands/pathology , Vaginal Diseases/diagnosis , Adult , Biopsy , Cell Differentiation , Diagnosis, Differential , Diethylstilbestrol/adverse effects , Female , Humans , Infertility, Female/etiology , Leiomyomatosis/complications , Polyps/diagnosis , Uterine Neoplasms/complications , Vaginal Diseases/pathologyABSTRACT
Preinvasive lesions of the vagina are relatively rare, clearly defined afflictions, originating most of all in association with the highrisk human papillomavirus infection (HRâHPV). The most frequent appearance is in coincidence with preinvasive lesions of uterine cervix and in vaginal cuff after hysterectomy. Preinvasive vaginal lesions are divided into squamous lesions (vaginal intraepithelial neoplasia) and nonsquamous lesions. Vaginal adenosis belongs to nonsquamous vaginal preinvasive lesions and is a precursor lesion of vaginal clearâcell carcinoma. Surgical and nonsurgical techniques including laser destructive methods and local administration of 5-âfluorouracile are used in the treatment of preinvasive lesions of vagina.
Subject(s)
Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Vaginal Neoplasms/diagnosis , Female , Humans , Papillomavirus Infections/pathology , Papillomavirus Infections/therapy , Precancerous Conditions , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/therapy , Vaginal Neoplasms/pathology , Vaginal Neoplasms/therapyABSTRACT
The mucosa of vagina in normal women is lined with thick nonkeratinizing squamous epithelium. The vaginal adenosis is defined as the abnormal presence of glandular epithelium or columnar epithelium with secretary product in the vagina. The incidence of vaginal adenosis was highly increased when diethylstilbestrol(DES) was in wide use by the mid 1940s. A 44-year-old woman without the previous intrauterine DES-exposure visited our clinic with pain on external genital area and erosive red erythematous patch on the vagina. Histopathologically, the multiple glands consisted of the columnar epithelium existed in the lamina propria of vaginal mucosa. And the lining cells resembled those cells of the fallopian tube and endometrium, namely mucinous columnar cells. We report a case of vaginal adenosis in a 44-year-old woman.
