Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report.

Abstract

Primary vaginal cancer is a rare malignant tumor; its pathogenesis remains unclear and only a limited number of cases have been documented in the literature. The present report outlines a rare case of primary vaginal endometrioid adenocarcinoma that occurred in a patient 3 years after a total hysterectomy for uterine adenomyosis. Pathogenesis, clinical features, diagnosis, treatment and prognosis are discussed to improve clinical recognition and management of this rare condition. A 49-year-old female patient who had undergone a total hysterectomy for uterine adenomyosis 3 years earlier presented with postcoital vaginal bleeding. Gynecological examination identified a mass in the vaginal stump. A biopsy revealed low-grade vaginal adenocarcinoma. The patient underwent an extensive laparoscopic parametric resection, partial upper vaginectomy, pelvic lymph node dissection and bilateral oophorectomy. The postoperative pathology determined a diagnosis of primary vaginal endometrioid adenocarcinoma. Concurrent chemoradiotherapy was initiated 6 weeks after surgery. At the last follow-up (15 months postoperatively), the patient was in good general condition with no evidence of recurrence. The present case indicates that long-term surveillance of the vaginal stump is valuable for patients who have undergone total hysterectomy for benign uterine diseases, as it allows early detection of vaginal stump lesions. In particular, for patients with a history of other malignant tumors, specific attention should be paid to the genetic susceptibility of the underlying tumor.