Non-diethylstilbestrol exposed vaginal clear cell adenocarcinoma has a common molecular profile with ovarian clear cell adenocarcinoma: A case report

Fertility sparing treatment of vaginal clear cell adenocarcinoma in a DES-Naïve young woman

Background

Primary vaginal cancer is rare and comprises 1-2% of female genital tract cancers. Among the types of vaginal cancer, adenocarcinoma accounts for only 10% with the peak incidence in women less than 20 years old. Clear cell type vaginal adenocarcinoma is most associated with exposure to diethylstilbestrol (DES) in-utero.

Case

We present a case of an 18-year-old nulliparous woman, DES-exposure naive, who was diagnosed with stage I clear cell vaginal adenocarcinoma during a routine pelvic exam for abnormal vaginal bleeding. She underwent a fertility-preserving radical vaginectomy and pelvic lymphadenectomy with neovagina creation and uterovaginal cervical reconstruction. She has been without disease for 28 months.

Conclusion

Although rare, vaginal cancer can be diagnosed on routine women's health exams. Early screening and diagnosis allow for innovative fertility-preserving surgical approaches without compromising oncologic outcomes. To our knowledge, this is the first case of a fertility-preserving radical vaginectomy, neovagina creation using a vertical rectus abdominis myocutaneous (VRAM) flap, and uterocervicovaginal reconstruction to successfully treat early stage clear cell vaginal adenocarcinoma with surgery alone, sparing the patient from adjuvant chemotherapy or radiation.

Primary clear cell adenocarcinoma of the vagina not associated with diethylstilbestrol: A case report

Primary vaginal cancers are rare and clear cell adenocarcinoma is a malignant tumor that is all the more rare when the woman has not been exposed in utero to synthetic diethylstilboestrol (DES). We report the case of a 60-year-old woman with a history of balanced essential hypertension and partial mastectomy for neoplasia, who presented with a recurrent left inguinal adenopathy. Clinical examination revealed a 3 cm bulging lesion of the anterior vaginal wall in the lower third with indurated left inguinal adenopathy. Biopsy of the nodule showed an invasive clear cell adenocarcinoma. The extension bialn is negative and the multidisciplinary decision is to perform a partial colpectomy with bilateral inguinal curage. The patient is currently undergoing radiochemotherapy. This is a rare case with a poor prognosis. A poor response to adjuvant therapy with a high frequency of distant metastases is reported in the literature. Due to the rarity of this pathology, individual experience based on case reports is the main source of information. The most effective mode of treatment therefore remains unknown and depends on patient-specific factors such as tumor size, surgeon and oncologist team experiences.

Anterior Pelvic Exenteration for Chemo-irradiated Non-diethylstilbestrol Exposed Clear Cell Vaginal Cancer

BACKGROUND/AIM

Clear cell vaginal adeno-carcinomas are rare tumors occurring in women which are usually treated by chemo radiotherapy with good outcomes. However, in certain cases, this treatment is not associated with complete response and a further surgery is needed.

CASE REPORT

We present the case of a 38-year-old patient diagnosed with stage IVA clear cell vaginal cancer who had been previously submitted to radio chemotherapy and in whom the lesion persisted after the oncological treatment; therefore, the patient was proposed for surgery with curative intent. The tumor was resected by performing an anterior pelvic exenteration with good outcomes, the patient being discharged in the seventh postoperative day. At one-year follow-up the patient remains free of recurrent disease.

CONCLUSION

Pelvic exenteration with curative intent might be the option of choice for persistent locally advanced clear cell vaginal cancer.