rare case of vaginal scc in prolapse

2. ABSTRACT
Primary vaginal cancer combined with uterine prolapse is very rare,constituting 1-2% of
all gynecological malignancies.
Usually occurs in patient over 60 yrs of age.
Commonly located in posterior upper third of vagina and commonest is Epidermoid cancer.
Treatment depends upon the degree of tumour infiltration and prognosis factors.
With a review of related literature ,we report a case of patient presented to our hospital with
Primary vaginal cancer in a third degree prolapse patients
Standardised therapy is not established.

3. CASE REPORT
A 70 yr old patient (P6L6) ,ALL HOME vaginal deliveries admitted with third degree
Irreducible Uterine prolapse and a non healing ulcer of vagina .She had a prolapsed uterus of
Third degree for past 10 years with foul smelling discharge and severe pelvic pain.
Physical examination reveals a third-degree prolapsed uterus with cystocele.
An illdefined ulcer of 6x4cm in size was present in the middle third of lateral and posterior
Vaginal wall with marked edema and ulceration of surrounding tissue.
Ulcer was 4 cm away from the cervix..
Multiple punch Biopsies were taken from the ulcerated vaginal lesion.Histopathology showed
squamous cell carcinoma of the vagina.

4. EXAMINATION
GENERAL EXAMINATION: she was Ill built,moderately nourished,not pale,
No lymphadenopathy.
OTHER SYSTEM EXAMINATION : CVS: S1S2 Heard,ESM present in aortic area.
RS: Bilateral vesicular breath sounds heard.CNS:NFND
LOCAL EXAMINATION : An illdefined ulcer of 6x4cm in size was present in the middle
third of lateral and posterior
Vaginal wall with marked edema and ulceration of surrounding tissue.
Ulcer was 4 cm away from the cervix.
PER RECTAL EXAMINATION : No adnexal mass.uterus of normal size,confirmed by USG
COLPOSCOPY : Unsatisfactory.Cervical biopsy taken and found as non specific
Chronic cervicitis

5. INVESTIGATIONS
Hb: 10GMS/dl, Platelets: 2.2lakhs, TC:7800, RBS:100mgs/dl, Urea:20mgs/dl,
Creatinine:0.8mgs/dl
Total bilirubin:0.6mg/dl, SGOT:38U/L, SGPT:24/L, Total Protein:6.8g/dl,
Blood grouping and typing. HIV : NR, HBsAg: negative
VIA: Coarse mosaic pattern on application of 5% acetic acid.
BIOPSY: Histopathology showed well differentiated squamous cell carcinoma of
vagina
MRI of abdomen and pelvis: Uterine prolapse with cystocele,B/L HUN,calcific foci in
the
right Lobe of liver

6. MRI IMAGES

7. SQUAMOUS CELL CA-HPE

8. BEFORE RADIOTHERAPY

9. AFTER 15 CYCLES OF RADIOTHERAPY

10. AFTER 21 CYCLES OF RADIOTHERAPY

11. AFTER 25 CYCLES OF RADIOTHERAPY

12. AFTER 5 CYCLES OF INTRA CAVITARY
RADIOTHERAPY

13. DISCUSSION
 EVEN AMONG THE DISEASE WHICH OCCUR AFTER MENOPAUSE, VAGINAL
CANCER IS VERY RARE
 IF VAGINAL LESIONS ARE RELATED TO CERVIX OR VULVA, IT IS PRIMARILY
DIAGNOSED AS EITHER CERVICAL OR VULVAL CANCER
 CHOICE OF TREATMENT DEPENDS ON PROGNOSTIC FACTORS,
LESION SIZE
LOCATION
DEGREE OF INFILTRATION
AGE
CLINICAL STAGE
HISTOLOGY

14.  MOST PREFERRED TREATMENT IS RADIOTHERAPY
 SIZE AND LOCATION OF LESION MUST BE WELL ESTABLISHED TO
DETERMINE THE DOSE AND TYPE OF RADIATION

15. LOWER THIRD OF VAGINA – CLINICAL STAGE 1
 UPPER REGION : COMBINATION OF EXTERNAL BEAM &
INTRACAVITARY RADIATION & THERAPEUTIC RANGE SIMILAR TO
CA CERVIX
 LOWER REGION : RESECTION OF INGUINOFEMORAL
LYMPHNODES INCLUDING EXTERNAL GENETALIA
 CONSERVATIVE Rx : YOUNG PATIENTS WITH VERUCOUS CA /
MICROINVASIVE CA

16. CONCLUSION
70 YEAR OLD POSTMENOPAUSAL WOMAN PRESENTED WITH IRREDUCIBLE UV
PROLAPSE WITH SCC, WHO WAS UNFIT FOR SURGERY DUE TO CARDIAC
REASON (SEVERE AS), RECEIVED 25 CYCLES OF EBRT AND 5 CYCLES OF
INTRACAVITARY RT, AND THE PROLAPSE GOT REDUCED WITH SHRINKAGE OF
SCC. PATIENT IMPROVED SYMPTOMATICALLY. HENCE RADIOTHERAPY SHOULD
BE THE PREFERRED TREATMENT OF CHOICE FOR POSTMENOPAUSAL WOMEN
WITH PRIMARY VAGINAL CARCINOMA IN UV PROLAPSE.