Carcinoma of the vagina presenting as a ruptured procidentia with an entero-vaginal fistula and prolapse of the small bowel

Using a pessary during radiotherapy in reducible pelvic organ prolapse and vaginal cancer: a case report and review of the literature

Purpose

Primary vaginal cancer and pelvic organ prolapse (POP) combination is extremely rare. Although definitive chemoradiotherapy (CRT) and brachytherapy (BT) is the standard treatment for advanced stage primary vaginal cancer, there is a limited data about the treatment of primary vaginal cancer combined with POP due to its rarity. In addition, radiotherapy (RT) process may be difficult in these cases and often result in more toxicity.

Case presentation

In this case report, we present a 77-year-old woman with a diagnosis of primary vaginal cancer associated with POP, who was treated with definitive CRT using a pessary to restore vaginal anatomy for optimal radiation. Following CRT, complete response was observed and vaginal cuff BT was performed. The patient tolerated the treatment very well and is still alive without disease at 10-months follow-up.

Conclusions

Combined primary vaginal cancer and POP is an extremely rare clinical entity, with only a few cases reported in the literature. When applying CRT in these cases, critical organ doses may be higher than expected due to the downward descent of the pelvic organs. Especially in elderly patients, a pessary can be used as a non-surgical procedure to restore the anatomy for symptom relief during definitive CRT. Additionally, it allows tumors to be targeted more precisely.

Primary vaginal squamous cell carcinoma with bladder involvement in uterine prolapsed patient: Case report

RATIONALE

Primary vaginal squamous cell carcinoma (SCC) is a rare disease. Primary SCC in prolapsed vagina is extremely rare. In the presented case additional bladder involvement was found.

PATIENTS CONCERNS

Primary vaginal SCC may be misinterpreted as decubitus in prolapsed vagina and it may delay proper diagnosis and treatment.

DIAGNOSES

Diagnosis was confirmed by the vaginal ulceration biopsy and cystoscopic biopsy of the involved bladder.

INTERVENTIONS

In the case presented percutaneous nephrostomy was the only possible treatment of hydronephrosis.

OUTCOMES

In advanced primary SCC (Figo IVA) with nodal involvement palliative treatment is only option.

LESSONS

Primary SCC mimicking decubitus which appeared in prolapsed vagina, may be accompanied by bladder involvement.

A case of vaginal cancer with uterine prolapse

Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 × 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis.

Primary invasive carcinoma of vagina with third degree uterovaginal prolapse: a case report and review of literature

BACKGROUND

Primary vaginal carcinoma associated with third degree uterovaginal prolapse is very rare.

CASE

We present a case report of a postmenopausal woman who presented with an invasive carcinoma of vagina associated with third degree uterovaginal prolapse treated by Mitra's operation. She was asymptomatic and had no recurrence during last 1 year of follow-up.

CONCLUSION

Vaginal ulcer associated with long standing genital prolapse need careful evaluation (including punch biopsy) for underlying carcinoma. Treatment due to the rarity of this entity was controversial previously and current review of literature suggests surgical treatment with or without radiotherapy as the optimum treatment for early stage and radiotherapy for advanced stage vaginal carcinoma associated with genital prolapse. Early diagnosis with adequate treatment can minimize the morbidity and mortality associated with vaginal carcinoma.

Vaginal carcinoma in a completely prolapsed uterus. A case report

BACKGROUND

The development of genuine vaginal carcinoma onto a completely prolapsed uterus is a very rare condition to deal with.

CASE

We report here the clinical characteristics of a patient with vaginal carcinoma associated with a third-degree prolapsed uterus. The 80-year-old patient was admitted with a completely prolapsed uterus. The cervix was clinically normal but on the nearby prolapsed vaginal wall a large exophytical hard lesion had been developed. Biopsy of the lesion revealed squamous carcinoma.

TREATMENT

The treatment performed was radical vaginal hysterectomy and excision of the upper two-thirds of the vagina without pelvic lymphadenectomy, followed by external beam irradiation. The patient is alive, with no signs of the disease 3.5 years after surgery.

CONCLUSION

Surgical and radiotherapeutic treatments can be effectively combined in patients with vaginal carcinoma and complete genital prolapse, in order to improve survival benefits and reduce morbidity.

Vaginal evisceration

Intestinal evisceration through the vagina is exceptionally rare. We report the cases of two patients presenting with this unusual clinical condition. Predisposing factors and management of vaginal evisceration are discussed.

Vaginal evisceration

A case of spontaneous vaginal evisceration is presented. Predisposing causes are the postmenopausal atrophic vagina, previous vaginal surgery, and the presence of an enterocele. Successful outcome is dependent on early recognition and surgical management.