Stage I endometrial adenocarcinoma with a vaginal nodule-the importance of differential diagnosis.

Endometrial cancer is a common malignancy of the female reproductive system. Most are early-stage but can spread locally and metastize (also to the vaginal wall). We report 2 clinical cases of post-menopausal women with early-stage endometrial cancer, after hysterectomy, who were offered adjuvant brachytherapy as monotherapy according to pathological stage and histology. On gynecological examination before brachytherapy, a vaginal nodule was identified in both patients, clinically compatible with a metastatic lesion. However, a biopsy was requested and histology classified both lesions as vaginal leiomyomas. The patients then proceeded with their initial strategy. It is therefore imperative to obtain histological confirmation of any new finding that may restage and alter the planned adjuvant treatment, to better adjust treatment to the correct stage, predict prognosis, and avoid iatrogeny. In this article, we highlight the importance of a thorough differential diagnosis and biopsy confirmation of any vaginal lesion that may change the adjuvant management of an early-stage endometrial tumor, and review published literature on vaginal leiomyomas.