Incidental Diagnosis of Primary Vaginal Adenocarcinoma of Intestinal Type

Primary vaginal adenocarcinoma of intestinal-type: case report of a rare gynaecological tumour

Vaginal cancer is rare and accounts for only 1 to 2% of all gynaecological malignancies. They arise as primary squamous cell cancers or are the result of extension from the cervix or vulva. Primary mucinous vaginal adenocarcinoma of intestinal-type is an extremely rare malignancy of unknown histogenesis with a diagnostic dilemma for the clinician and histopathologist. We presented the case of a 40-year-old Para 0⁺² woman with the complaint of a mass in the vagina and recurrent vaginal bleeding who was evaluated and worked-up for examination under anaesthesia and biopsy of the vaginal mass. The histological examination revealed the unusual intestinal-type variant of adenocarcinoma of the vagina. Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease as primary vaginal cancer.

Poorly differentiated vaginal adenocarcinoma with aggressive behavior-Pap smear findings

Vaginal carcinoma is a rare condition. In this report, we describe a case of a poorly differentiated aggressive adenocarcinoma in a woman with a three month history of vaginal bleeding and a negative Pap smear done six months prior to her consultation. Specular examination showed a normal cervix, but there was a bleeding ulcer (2 cm in diameter) in the upper third of the vagina. Cytology revealed poorly differentiated atypical cells, and the biopsy established a diagnosis of vaginal adenocarcinoma with little differentiation. Within two months, the patient died without diagnosis of a primary tumor site other than the vagina.

Primary vaginal mucinous adenocarcinoma of intestinal type, associated with intestinal metaplasia of Skene ducts in a diethylstilbestrol-exposed woman

OBJECTIVES

Primary mucinous vaginal adenocarcinoma of intestinal type is an extremely rare malignancy of uncertain histogenesis, which makes for a diagnostic challenge. We report a case and describe the histopathologic features and the unusual immunoprofile of this rare entity.

METHODS

We report a case of vaginal mucinous adenocarcinoma of intestinal type in a diethylstilbestrol-exposed woman in which intestinal metaplasia of the Skene duct was found at the time of recurrence.

RESULTS

As the histogenesis of primary vaginal intestinaltype adenocarcinomas remains uncertain, the finding of Skene duct metaplasia in association with invasive adenocarcinoma lends support to the origin of vaginal mucinous adenocarcinomas of intestinal type to be metaplasia, at least in some cases. Such an origin accounts for the unusual immunohistochemical profile, which raises concern for a metastatic adenocarcinoma of gastrointestinal origin.

CONCLUSIONS

Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease.

[Primary vaginal adenocarcinoma of intestinal type: case report and review of literature]

L'adénocarcinome vaginal de type intestinal est une tumeur rare. Il pose un problème d’étiopathogénie, de diagnostic différentiel (avec un ADK rectal ou métastatique) et de prise en charge thérapeutique. Nous rapportons le cas d'une patiente de 46 ans, qui présente depuis 8mois des leucorrhées brunâtres. L'examen clinique trouve la présence d'une lésion infiltrante de 4cm, au dépend de la paroi postérieure du vagin avec envahissement de la cloison recto-vaginale. La biopsie a révélé un adénocarcinome colloïde muqueux de type intestinal. Cette interprétation histologique orientait vers une métastase vaginale d'un ADK gastro-intestinal, cependant, l'examen clinique, la recto-coloscopie, le scanner abdominal et l'imagerie par résonance magnétique (IRM) pelvienne ont permis d'exclure cette possibilité. La patiente a reçu une radio-chimiothérapie concomitante (RCC), suivie d'une résection chirurgicale. L'examen anatomopathologique de la pièce opératoire a montré une stérilisation totale de la tumeur. Après 2 ans de suivi la patiente a développée des métastases osseuses multiples témoignant de l'agressivité de cette tumeur.

Retroperitoneal adenocarcinoma of unknown origin presenting as a rare cause of obstructed labor

BACKGROUND

Metastatic retroperitoneal adenocarcinoma presenting as obstructed labor is extremely rare.

CASE

An unbooked 35-year-old multipara came to our casualty in obstructed labor at 38 weeks of pregnancy. A palpable retroperitoneal mass was found behind the gravid uterus and cervix after delivery of a live baby during emergency cesarean section. Needle biopsy was taken from the mass and abdomen was closed due to nonavailability of frozen section facility at night. Post cesarean section CT scan confirmed the pelvic mass, which was subjected to open biopsy. A diagnosis of retroperitoneal adenocarcinoma with an unknown primary was made based on histopathology and a negative workup for the possible primary sites. Patient was treated successfully with chemotherapy and did not show recurrence for last 2 years of follow-up.

CONCLUSION

Surgeons should be aware of this extremely rare entity and it highlights the importance of proper antenatal care to pick up such pathology at an early stage by careful examination and ultrasound to minimize the morbidity and mortality. We also suggest frozen biopsy in a suspected pelvic mass during surgery and early cesarean section to avoid the complications of obstructed labor in such advanced stages of malignant tumor.