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Snapshot
  • A 62-year-old women presents with abnormal vaginal bleeding. She underwent menopause at the age of 50. Pelvic examination is unremarkable. Vaginal cytology is abnormal, and she undergoes vaginal colposcopy. A biopsy is taken which is positive for vaginal squamous cell carcinoma.
Introduction
  • Overview
    • malignancy affecting the vagina
      • most common histologic type is squamous cell carcinoma
        • most commonly secondary to squamous cell carcinoma of the cervix
  • Epidemiology
    • incidence
      • comprises ~3% of all malignancies involving the female genital tract
      • mean age of diagnosis is ~60 years
    • risk factors
      • human papillomavirus (HPV) infection
      • extension from malignant cervical disease 
      • diethylstilbestrol (DES)
        • associated with adenocarcinoma of the vagina 
Presentation
  • Symptoms
    • vaginal bleeding (most common)
      • may be postcoital, intermenstrual, or postmenopausal
  • Physical exam
    • vaginal mass may be noted
Studies
  • Lab studies
    • vaginal cytology
  • Invasive studies
    • vaginal colposcopy
      • indication
        • performed if cytology is abnormal
    • vaginal biopsy
      • indication
        • confirms the diagnosis
  • Histology
    • squamous cell carcinoma
      • most common histological type
    • clear cell adenocarcinoma
      • secondary to DES exposure in utero
      • typically presents in women < 20 years of age
    • sarcoma botryoides ("botrys" is Greek for "grapes")
      • affecting girls < 4 years of age
      • appears as a polypoid (or grape-like) mass that emerges from the vagina
      • contains spindle-shaped cells and are positive for desmin
Differential
  • Cervical cancer
    • differentiating factors
      • evidence of dysplastic or malignat cells in the cervix only
Treatment
  • Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor
Complications
  • Treatment-related complications
    • rectal and vaginal strictures
    • urethral, bladder, and/or rectal injury
 

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