Bladder cancer will grow anywhere: report of a urothelial carcinoma drop metastasis to the vagina and literature review.

Urothelial carcinoma is the 2nd most common cancer of the urinary tract and accounts for the majority of cases of bladder cancer. Metastases are not infrequently encountered, increasing with disease stage and are most commonly seen in the bones and lungs. Many other sites have been described including the omentum, liver, and ovaries. An extremely rare site of metastatic disease however is within the vagina. Here we present a case of a probable vaginal 'drop metastasis' from previously treated urothelial carcinoma in the ureter and bladder.

Recto-vaginal septum cystadenocarcinoma: a case report and review of the literature.

BACKGROUND: Carcinoma of the recto-vaginal septum is a quite rare location and related to peritoneal and primary ovarian carcinomas. There are only few reports in the literature with a very poor prognosis. CASE PRESENTATION: Here we report the case of a 63 years old woman with past medical history of left oophorectomy presenting with a pelvic pain. The magnetic resonance imaging (MRI) demonstrated a 10 cm mass located in the recto-vaginal septum. A block resection was performed allowing the retrieval of a 10 cm solid tumor of the recto-vaginal septum. Peritoneal biopsies and the right ovary were normal the final diagnosis was cystadenocarcinoma of the recto-vaginal septum. The patient received adjuvant chemotherapy and displays no sign of recurrence 36 months after diagnosis. CONCLUSION: The management of recto-vaginal septum carcinoma with en bloc resection should be performed to avoid peritoneal spread and improve prognosis.

Vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving chemotherapy and conservative surgery.

Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of invasive vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving neoadjuvant chemotherapy and conservative surgery. A 36-year-old non-parous woman had a solid tumor in the vagina. Positron emission tomography/computed tomography showed a tumor in the vagina with high FDG uptake (SUV = 17.33) but no metastatic lesions. The patient was diagnosed with vaginal squamous cell carcinoma, FIGO stage I, T1N0M0. Because she wished to retain her fertility, neoadjuvant chemotherapy consisting of irinotecan hydrochloride and nedaplatin was initiated. After four courses of chemotherapy, partial vaginectomy was carried out and the pathological diagnosis of the residual lesion was VAIN 3. Following two further courses of the same chemotherapy, she obtained complete response, and has shown no evidence of disease for 14 months.

Metástasis vaginales de tumores colorrectales / Vaginal metastasis of colorectal tumours

Las metástasis vaginales de tumores extragenitales son extremadamente raras. El primer síntoma más frecuentemente referido es el sangrado vaginal, aunque muchas veces el diagnóstico suele ser casual, en una revisión ginecológica de control o mediante una prueba de imagen. El tratamiento es controvertido y debe individualizarse. Debido a su baja incidencia, no estarían indicadas una colposcopia y vaginoscopia rutinaria en el seguimiento de estas pacientes. Sin embargo, la revisión ginecológica debe ser rutinaria y se debe tener presente la posibilidad de una metástasis vaginal ante cualquier lesión en la vagina o sangrado vaginal. Describimos 3 casos de metástasis vaginal del cáncer colorrectal diagnosticados en el Hospital Donostia de San Sebastián (AU)

Vaginal metastases of extragenital tumours are extremely rare. The most frequent first symptom is vaginal bleeding, although the diagnosis is often a casual finding during a gynaecological check-up or by an imaging test. Treatment is controversial and should be individualized. The incidence is very low and colposcopy and vaginoscopy are not necessary in the routine monitoring of these patients. However, the routine gynaecological examination is required, and the possibility of a vaginal metastasis should be taken into account if there is any vaginal lesion or bleeding. We report three cases of vaginal metastasis of colorectal cancer diagnosed in Donostia Hospital (AU)

History of incidence of autoimmune and oncological diseases in identical female twins.

PROBLEM: The aim of study was to investigate identical female twins born in 1977 suffered from autoimmune diseases (twin A - Sjogren's syndrome, and twin B - systemic lupus erythematosus). METHOD OF STUDY: It was refer retrospective analysis of both sisters suffered beside autoimmune alterations (Sjogren's syndrome and systemic lupus erythematosus) also from gynecological diseases (twin A - praecancerosis of cervix uteri, twin B - carcinoma vaginae). RESULTS: Relationships between disease activities and severities in the female twins were similar and the treatments were directed according to clinical symptoms and laboratory results. Dramatic change, unfortunately, occurred with twin B. The reason may be the association between SLE activity (lupus nephritis), hematological complication (leukopenia) and oncological vaginal recidivation. CONCLUSION: Association between autoimmune disease and gynecological cancer (or praecancerosis) is major risk than without immunology deviation. Twin A is periodically gynecologically observed.

Severe vaginal pain caused by a neuroma in the rectovaginal septum after posterior colporrhaphy.

BACKGROUND: Traumatic vaginal neuromas are a rarely documented finding in the setting of vaginal pain after posterior colporrhaphy. They arise as a result of trauma or surgery and are often mistaken for scar tissue. CASE: After a total vaginal hysterectomy and posterior colporrhaphy, a 32-year-old woman presented with debilitating vaginal pain, presumed to be secondary to scar tissue formation. Excision of the tissue from the rectovaginal septum revealed a traumatic neuroma. After the removal of the neuroma, the patient's vaginal pain resolved. CONCLUSION: Traumatic neuromas may be a cause of significant point tenderness and thickened tissue after vaginal surgery or repair of obstetric lacerations. If conservative treatment methods have failed, surgical excision of the neuroma can be considered.

Recurrent primary vulvovaginal malignant melanoma arising in melanoma in situ--the natural history of lesions followed for 23 years.

Multifocal melanoma and melanoma in situ of the vulva and vagina are uncommon lesions, and our understanding of their natural history is limited. Vulvovaginal melanoma appears to be biologically different from cutaneous melanoma and has more in common with mucosal melanoma. A 60-year-old woman presented in 1977 with a pigmented vulvar lesion. Histologic examination revealed melanoma in situ associated with focal invasive melanoma. She re-presented with recurrent primary melanomas arising in melanoma in situ in 1990 and 1998 and died of widespread metastatic melanoma in 2000. Melanoma in situ of the vulva and vagina is rare and appears to have a relatively slow but definite progression to invasive melanoma. All suspicious pigmented lesions in this region should be biopsied, and if multifocal in situ melanoma is identified, vulvo(vagin)ectomy should be considered.

Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer.

PURPOSE: To investigate the longitudinal course of self-reported sexual function and vaginal changes in patients disease free after radiotherapy (RT) for locally advanced, recurrent, or persistent cervical cancer. MATERIALS AND METHODS: A total of 118 patients referred for RT were included. The patients were assessed, using a validated self-assessment questionnaire, at the termination of RT and 1, 3, 6, 12, 18, and 24 months later. The results were compared with an age-matched control group from the general population. RESULTS: Persistent sexual dysfunction and adverse vaginal changes were reported throughout the 2 years after RT, with small changes over time: approximately 85% had low or no sexual interest, 35% had moderate to severe lack of lubrication, 55% had mild to severe dyspareunia, and 30% were dissatisfied with their sexual life. A reduced vaginal dimension was reported by 50% of the patients, and 45% were never, or only occasionally, able to complete sexual intercourse. Despite sexual dysfunction and vaginal adverse effects, 63% of those sexually active before having cancer remained sexually active after treatment, although with a considerably decreased frequency. CONCLUSIONS: Patients who are disease free after RT for locally advanced, recurrent, or persistent cervical cancer are at high risk of experiencing persistent sexual and vaginal problems compromising their sexual activity and satisfaction.

Presentación tardía de carcinoma vaginal posneoplasia intraepitelial cervical III / Late presentation of vaginal carcinoma after cervical intraepithelial neoplasia grade III

Se presenta un caso de carcinoma escamoso de vagina, concurrente con fístula rectovaginal, a los 9 años de una histerectomía abdominal por NIC III de recurrencia, asociada a la presencia de HPV16.Se discute la aproximación individual adecuada en pacientes con problemas en la erradicación de neoplasia intracervical III (AU)

Linfoma de vagina en gestante / Vaginal lymphoma in pregnancy

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Solitary fibrous tumor of the vagina.

The solitary fibrous tumor (SFT) is a rare tumor that most commonly arises in the pleura. Recent evidence has indicated that this tumor originates from mesenchymal, probably fibroblastic, cells and is not restricted to the pleura. However, its occurrence in the female genital tract is extremely rare. We report a case of primary SFT that originated from the vagina in a 34-year-old female. It was a pedunculated polypoid tumor and occurred at the site of scar tissue, caused by laceration during her last labor 7 years previously. Histologically, the tumor was predominantly composed of a random proliferation of spindle cells, intimately admixed with collagen. Immunohistochemically, the cells were strongly positive for CD34, vimentin and bcl-2, but were negative for S-100 protein, neuron-specific enolase, smooth muscle actin, desmin, CD68, cytokeratins and epithelial membrane antigen. To the best of our knowledge, this is the first reported case of a primary vaginal SFT in the English literature. Our report suggests to include SFT in the differential diagnosis of a spindle cell neoplasm originating from the vagina.

Non-Hodgkin's lymphoma involving the vagina: a clinicopathologic analysis of 14 patients.

Non-Hodgkin's lymphomas (NHL) uncommonly involve the vagina. In this study, 14 NHL involving the vagina are reported. Eight cases were stage IE or IIE and are presumed to be primary. The mean age of these eight patients at presentation was 42 years (range, 26-66 yrs), and four of eight patients complained primarily of vaginal bleeding. Histologically, all eight neoplasms were diffuse large B-cell lymphoma (DLBCL). Clinical follow up ranged from 1.8 to 18 years. Six of eight patients were alive without evidence of disease at the last follow up (range, 2.8-21 yrs), one patient died of unrelated causes at 9 years, and one patient died from NHL at 1.8 years. In six patients vaginal involvement was part of systemic disease at diagnosis, either stage IIIE or IV. The mean patient age at the time vaginal involvement was detected was 65 years (range, 49-82 yrs). Four of six patients had vaginal bleeding. Five neoplasms were DLBCL and one tumor was B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia. Clinical follow up for these patients ranged from 2 weeks to 13 years. Two patients were free of disease after treatment at 4.5 and 13 years, two patients were alive with progressive NHL, one patient died of NHL, and one patient was recently diagnosed. The authors conclude that low-stage (presumably primary) vaginal NHL are DLBCL, tend to occur in younger women, and cause vaginal bleeding. High-stage NHL involving the vagina are usually DLBCL, tend to affect older women, and are relatively more heterogeneous clinically and histologically, but also usually cause vaginal bleeding.

Tratamiento del dolor ginecológico de origen canceroso / Management of gynecological pain associated to cancer

Todo cáncer de origen ginecológico puede producir en cualquier momento de su evolución un dolor importante, traduciéndose desde el momento de su aparición en un verd a d ero "marcador" clínico de la recidiva del cáncer ginecológico.Como en toda patología oncológica el primer tratamiento del dolor debe ser etiológico pero el tratamiento sintomático debe de iniciarse sin esperar los resultados de los análisis y exámenes paraclínicos pedidos.Tratar un paciente con cáncer ginecológico requiere una estrategia diagnóstica y terapéutica rigurosa, estableciendo un examen semiológico detallado para determinar el origen fisiopatológico del dolor.Realizar una evaluación y medición del dolor es muy importante ya que aporta elementos suplementarios a la semiología del dolor que permitirán posteriores evaluaciones terapéuticas, así como ajustes de dosis e implementación de nuevas técnicas y utilización de medicamentos coadyuvantes. Además es importante conocer las repercusiones del dolor en la calidad de vida del paciente, lo cual se logra con la aplicación de escalas de calidad de vida.El manejo y tratamiento del dolor oncológico de origen ginecológico debe ser multifactorial utilizando los diversos tratamientos antineoplásicos clásicos tales como: la radioterapia, quimioterapia y cirugía, siempre en yuxtaposición al tratamiento del dolor lo cual permitirá obtener óptimos resultados y mejorará la calidad de vida de nuestras pacientes (AU)

Paraganglioma of the vagina: the first report of a rare tumor in a child.

Paraganglioma (extra-adrenal pheochromocytoma) is a rare tumor, particularly in childhood. Those in the female genital tract are exceptionally rare, with only 9 cases reported in detail since 1926. All were seen in adults and only two arose in the vagina. This study examined the incidence of this tumor in the childhood population of the West Midlands region of the United Kingdom since 1957 and found 4 cases: 2 abdominal, 1 para-aortic, and 1 carotid body. A recent additional case is reported in the vagina of a child aged 11 years, who presented with heavy vaginal bleeding in the absence of hypertension. Initial diagnosis suggested rhabdomyosarcoma and near complete excision was carried out. Since this is the first such case to be described in a child, the outcome can only be assumed. Although histopathological examination suggested the benign nature of the tumor, implying that surgical excision was sufficient treatment, close follow-up is recommended.

Sonodynamic changes after transcatheter arterial embolization in a vaginal hemangioma: case report.

A 36-year-old pregnant woman with a rapidly growing hemangioma in the vagina was treated by transcatheter arterial embolization after delivery. Blood flow characteristics within the tumor were evaluated using transvaginal color Doppler ultrasound both before and after the embolization. The vascular resistance in the tumor vessels within the vaginal hemangioma was observed to be significantly decreased; the tumor reduced in volume following this non-surgical treatment.

Vaginal clear cell adenocarcinoma in an infant.

An infant girl who previously had hematuria was presented because of discharge of material from her genital area. Vaginal clear cell adenocarcinoma was diagnosed. Gynecological cancers in infant girls may be disclosed with hematuria.

Cell kinetic analysis of murine squamous cell carcinomas: a comparison of single versus double labelling using flow cytometry and immunohistochemistry.

The study was originally set up to measure accurate cell kinetic parameters in two murine squamous cell carcinomas (scc) for comparison with radiobiological data on proliferation during radiotherapy. The tumours, AT84 and AT478, were both moderately well differentiated aneuploid scc. In the course of the study, several comparisons of techniques were made in two different centres. This paper reports on the results of those comparisons involving two different detection methods (flow cytometry and immunohistochemistry), single vs double labelling, and in vivo and in vitro labelling, the latter using tissue slices incubated under high pressure oxygen. Pulse labelling studies with bromodeoxyuridine (BrdUrd) showed that the labelling indices (LI) were not significantly different after in vitro or in vivo labelling. In addition, the flow cytometry (FCM) and immunohistochemistry (IHC) methods also gave labelling indices which were not significantly different. Only tumour cells were analysed in these studies by selecting cells on the basis of aneuploidy (FCM) or morphology (IHC). The DNA synthesis time of the tumour cells were analysed by both techniques. For FCM, the Relative Movement method was used (Begg et al., 1985). For IHC, a double labelling method was used, employing BrdUrd and triated thymidine (3H-TdR) administered several hours apart, detected simultaneously using immunoperoxidase and autoradiography, respectively. When both labels were administered in vivo, there was good agreement for Ts between the FCM and IHC methods. Attempts were also made to measure Ts in vitro using both techniques. With double labelling, it was found that cells did not take up the second label, implying a failure of cycle progression. This was confirmed by FCM results, showing no movement of labelled cells through the S-phase, despite an initially high uptake. This could not be influenced by lowering the DNA precursor concentration or by adding foetal calf serum. This indicates that DNA synthesis times are difficult or impossible to measure in vitro in fresh tumour explants. Finally, the double labelling IHC method allowed intratumoural variations of both LI and Ts to be studied. Both parameters were found to vary markedly throughout the tumour volume, particularly for larger tumours (600 mg), giving calculated local potential doubling time values (Tpot) ranging from 1-7 days.

Endometrial response to endogenous hormones after pelvic irradiation for genital malignancies.

Two cases are presented which demonstrate histologically an endometrial response to endogenous hormones after pelvic teletherapy and brachytherapy in patients who have undergone lateral ovarian transposition. Reasons for such a response are briefly discussed.