Primary Vaginal Carcinoma in a Long Standing Rectocele: A Case Report and Review of the Literature

Abstract

Abstract

Background:

Primary vaginal cancer is rare, comprising 1%–2% of all gynecological malignancies. It is commonly seen in women aged 60–80. A primary vaginal carcinoma presenting in conjunction with pelvic organ prolapse is even more rare. This carcinoma usually involves the upper one-third of the anterior or posterior wall of the vagina. Primary vaginal carcinoma involving the lower one-third of the posterior vaginal wall and associated with uterovaginal prolapse is extremely rare and only 1 case has been reported in literature until now. This article reports a very rare case of a primary vaginal carcinoma in a long-standing isolated rectocele involving the posterior lower third of vaginal wall.

Case:

A 62-year old postmenopausal female presented with complaints of a mass protruding through her vagina for 22 years and bloodstained, foul-smelling vaginal discharge for 2 months. She had a history of chronic constipation for 12 years. Her vulva was healthy. A 4 × 4-cm exophytic growth, 1 cm from the fourchette and well away from the cervix, which bled on touch, was present over a grade 2 rectocele.

Results:

Histopathology of the vaginal biopsy demonstrated poorly differentiated squamous cell carcinoma. A diagnosis of International Federation of Gynecology and Obstetrics stage 1 primary carcinoma of the vagina with a rectocele was made. She was referred to the radiotherapy department for further treatment.

Conclusions:

In all patients with long-standing uterovaginal prolapse and postmenopausal bleeding, although the first differential diagnosis is a decubitus ulcer, the possibility of vaginal cancer should also be kept in mind. (J GYNECOL SURG 33:268)