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Kohut A, Whitaker T, Walter L, Li SY, Han E, Lee S, Wakabayashi MT, Dellinger TH, Han ES, Rodriguez-Rodriguez L, Chung C. Feasibility of combining pelvic reconstruction with gynecologic oncology-related surgery. Int Urogynecol J 2023; 34:177-183. [PMID: 35501570 DOI: 10.1007/s00192-022-05212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/12/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS At our institution, every patient seen by the gynecologic oncology service is screened for pelvic floor dysfunction. This study was aimed at determining if a combined surgical approach by gynecologic oncology and urogynecology services at our institution was feasible and safe for this patient population. METHODS We performed a retrospective review of patients undergoing combined surgery by gynecologic oncology and urogynecology services at our institution from 2013 to 2021. Perioperative variables, postoperative adverse events, and long-term outcomes were assessed, and descriptive statistics were performed. RESULTS From 20 December 2013 to 29 January 2021, a total of 102 patients underwent concurrent surgical repair of pelvic organ prolapse and/or stress urinary incontinence. Seventy-three patients (71.6%) had normal/benign pathologic conditions, and 29 (28.4%) had premalignant/malignant pathologic conditions. Ten patients (9.8%) had a postoperative complication, including reoperation for exposed midurethral sling (4.9%), urinary retention requiring midurethral sling release (2.9%), reoperation for hemoperitoneum (1.0%), and anemia requiring blood transfusion (1.0%). Nine complications occurred in patients with benign/normal pathologic conditions (12.3%), and one complication occurred in patients with pre-malignant/malignant pathologic conditions (3.4%). CONCLUSIONS In our single-institution experience, concurrent gynecologic oncology and pelvic floor reconstructive surgery were safe and feasible in combination with no reported major morbidity events.
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Affiliation(s)
- Adrian Kohut
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Taylor Whitaker
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Logan Walter
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Susan Y Li
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Elinor Han
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Stephen Lee
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Mark T Wakabayashi
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Thanh H Dellinger
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Ernest S Han
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Lorna Rodriguez-Rodriguez
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Christopher Chung
- Department of Surgery, Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
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2
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Frigerio M, Inzoli A, Barba M. Pelvic organ prolapse and vaginal cancer: a systematic literature review. Int J Gynaecol Obstet 2022; 159:365-371. [PMID: 35167139 DOI: 10.1002/ijgo.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary vaginal cancer is a rare gynecologic malignancy. Few cases about the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. OBJECTIVES To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. SEARCH STRATEGY We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, Cochrane using a combination of keywords and text words represented by a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse" and "vaginal cancer", "vaginal carcinoma" SELECTION CRITERIA: No article type restrictions were applied. DATA COLLECTION AND ANALYSIS Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients MAIN RESULTS: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. The surgical approach was the treatment of choice in most cases. On the contrary, exclusive interstitial brachytherapy was rarely performed. CONCLUSIONS A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.
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Malek B, Ines Z, Saida S, Ghada S, Maher S, Khaled R. Aggressive Behavior of Warty Squamous Cell Carcinoma of the Vagina Associated with Uterine Prolapsed: Unusual Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211011206. [PMID: 33994821 PMCID: PMC8108072 DOI: 10.1177/11795476211011206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/04/2020] [Indexed: 11/17/2022]
Abstract
Warty squamous cell carcinoma (WSCC), is a rare variant of squamous cell carcinoma that occurs mostly in younger women, but can occur in old women. It is due to human papillomavirus (HPV) infection. This rare entity has been described in several organs such as vulva, cervix, and penis. To the best of our knowledge WSCC of vagina associated with the third-degree of uterine prolapse has never been reported in the literature. We present an exceptional case of WSCC of vagina occurred in a 77-year-old woman with long disease duration. The physical exam found a large ulcer-budding lesion of the middle and lower third of the vagina that depends on the left vaginal wall. The full work-up concluded to stage IVA of FIGO classification, due to the bladder involvement. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic node dissection, left partial cystectomy with left ureteral reimplantation and total vaginectomy, followed by adjuvant radiotherapy. The patient had no recurrence during 8 years of regular follow-up. WSCC can express locally aggressive behavior, such we reported; despite it appears to be less aggressive than the typical well-differentiated squamous cell carcinoma. That leads to individualize WSCC from other verruciform neoplasms.
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Affiliation(s)
- Bouhani Malek
- Department of oncologic surgery, Salah Azaiz Institute, Tunis, Tunisia.,Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie
| | - Zemni Ines
- Department of oncologic surgery, Salah Azaiz Institute, Tunis, Tunisia.,Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie
| | - Sakhri Saida
- Department of oncologic surgery, Salah Azaiz Institute, Tunis, Tunisia.,Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie
| | - Sahroui Ghada
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Department of anatomopathology, Salah Azaiz Institute, Tunis, Tunisia
| | - Slimene Maher
- Department of oncologic surgery, Salah Azaiz Institute, Tunis, Tunisia.,Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie
| | - Rahal Khaled
- Department of oncologic surgery, Salah Azaiz Institute, Tunis, Tunisia.,Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie
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4
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Using a pessary during radiotherapy in reducible pelvic organ prolapse and vaginal cancer: a case report and review of the literature. J Contemp Brachytherapy 2020; 12:175-180. [PMID: 32395142 PMCID: PMC7207234 DOI: 10.5114/jcb.2020.92997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/15/2019] [Indexed: 01/21/2023] Open
Abstract
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.
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5
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Chung CP, Dao NT, Wakabayashi MT, Dellinger TH, Lee SJ, Han ES. Concurrent pelvic reconstruction and minimally invasive pelvic cancer surgery. Int Urogynecol J 2018; 29:1709-1711. [PMID: 30121701 DOI: 10.1007/s00192-018-3751-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present our experience in performing concurrent prolpase repair at the time of gynecologic cancer surgery. METHODS The uterosacral ligaments are tagged before performing hysterectomy and pelvic dissection. The uterosacral ligament suspensory sutures are then placed laparoscopically after completion of pelvic cancer surgery. The remainder of the prolapse surgery is performed through a transvaginal approach. RESULTS Many of our patients who undergo concurrent prolapse repair and gynecolgical cancer surgery receive chemotherapy and pelivc radiation. Concuurent prolapse repair improves their prolaspe symptoms. CONCLUSION Concurrent prolapse repair should be performed at the same time as gynecologic cancer surgery.
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Affiliation(s)
- Christopher P Chung
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - NhuChi T Dao
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Mark T Wakabayashi
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Thanh H Dellinger
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Stephen J Lee
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Ernest S Han
- Division of Gynecologic Oncology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
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Singhal SR, Agarwal K. Primary Vaginal Carcinoma in a Long Standing Rectocele: A Case Report and Review of the Literature. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Savita Rani Singhal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kriti Agarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
- Sanghi Hospital, Rohtak, Haryana, India
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Fedus T, Raś R, Książek M, Filipowska J, Kaznowska E, Skręt A, Skręt-Magierło J, Barnaś E. Primary vaginal squamous cell carcinoma with bladder involvement in uterine prolapsed patient: Case report. Medicine (Baltimore) 2017; 96:e8993. [PMID: 29390294 PMCID: PMC5815706 DOI: 10.1097/md.0000000000008993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
| | - Renata Raś
- Obstetrics and Gynecology Clinic, Frederick Chopin Clinical Provincial Hospital No 1
| | - Mariusz Książek
- Department of Patomorphology, Chair of Morphological Sciences, Faculty of Medicine
| | | | - Ewa Kaznowska
- Department of Patomorphology, Chair of Morphological Sciences, Faculty of Medicine
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Frederick Chopin Clinical Provincial Hospital No 1
| | - Joanna Skręt-Magierło
- Institute of Obstetrics and Emergency Medicine, Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Edyta Barnaś
- Institute of Obstetrics and Emergency Medicine, Medical Faculty, University of Rzeszow, Rzeszow, Poland
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8
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Wang Y, Li Q, Du H, Lv S, Liu H. Uterine prolapse complicated by vaginal cancer: a case report and literature review. Gynecol Obstet Invest 2014; 77:141-4. [PMID: 24481208 DOI: 10.1159/000357566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/26/2013] [Indexed: 11/19/2022]
Abstract
Primary vaginal cancer is not common, representing 1-2% of all female genital malignancies. We present a case of a third-degree uterine prolapse complicated by an isolated primary vaginal cancer and its surgical treatment. The cervix was clinically normal, but on the nearby prolapsed vaginal wall, a large exogenous hard lesion had developed. A biopsy of the lesion revealed a squamous carcinoma. The patient was asymptomatic and had no recurrence during the last 4 years of follow-up after surgical treatment with radiotherapy. The surgical treatment with or without radiotherapy is the optimum treatment for uterine prolapse with early-stage vaginal squamous cell carcinoma, although the majority of vaginal malignancies are treated with radiotherapy. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration.
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Affiliation(s)
- Yueling Wang
- Department of Obstetrics and Gynecology, Xi'an Jiaotong University, Xi'an, China
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9
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Primary vaginal carcinoma of lower one-third of posterior vagina associated with third-degree prolapse: a rare case. J Obstet Gynaecol India 2014; 63:356-8. [PMID: 24431677 DOI: 10.1007/s13224-012-0199-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 04/23/2012] [Indexed: 10/27/2022] Open
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10
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Kim HG, Song YJ, Na YJ, Choi OH. A case of vaginal cancer with uterine prolapse. J Menopausal Med 2013; 19:139-42. [PMID: 25371880 PMCID: PMC4217562 DOI: 10.6118/jmm.2013.19.3.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Hwi-Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ook-Hwan Choi
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
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Selvaggi F, Guadagni I, Pellino G, de Rosa M, Imbrogno G, Sciaudone G. Perianal Paget's disease happening with mucinous adenocarcinoma of the anal canal: managing rarities. J Cutan Pathol 2009; 37:1182-3. [DOI: 10.1111/j.1600-0560.2009.01395.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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A rare case of invasive vaginal carcinoma associated with vaginal prolapse. Arch Gynecol Obstet 2009; 280:845-8. [DOI: 10.1007/s00404-009-1016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 02/17/2009] [Indexed: 10/21/2022]
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13
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Duhan N, Kadian YS, Sangwan N, Sen R, Sirohiwal D, Rajotia N. Uterovaginal Prolapse and Cervical Cancer: A Coincidence or an Association. J Gynecol Surg 2008. [DOI: 10.1089/gyn.2008.b-02316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nirmala Duhan
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Yogender Singh Kadian
- Department of General Surgery, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Neetu Sangwan
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Rajeev Sen
- Department of Pathology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Daya Sirohiwal
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Nidhi Rajotia
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
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14
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Ghosh SB, Tripathi R, Mala YM, Khurana N. Primary invasive carcinoma of vagina with third degree uterovaginal prolapse: a case report and review of literature. Arch Gynecol Obstet 2008; 279:91-3. [PMID: 18936946 DOI: 10.1007/s00404-008-0815-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Sharda Brata Ghosh
- Department of Obstetrics, Gynaecology and Pathology, Maulana Azad Medical College, Lok Nayak Hospital, Delhi, 110002, India.
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