Plattenepithelkarzinom der Neovagina nach Mayer-Rokitansky-Küster-Hauser-Syndrom

Neovagina creation methods in Müllerian anomalies and risk of malignancy: insights from a systematic review

PURPOSE

This systematic review aims to provide a data synthesis about the risk of neovaginal cancer in women with Müllerian anomalies and to investigate the association between the adopted reconstructive technique and the cancer histotype.

METHODS

PubMed, MEDLINE, Embase, Scopus, ClinicalTrials.gov and Web of Science databases were searched from inception to March 1st, 2023. Studies were included if: (1) only women affected by Müllerian malformations were included, (2) the congenital defect and the vaginoplasty technique were clearly reported, (3) the type of malignancy was specified.

RESULTS

Literature search yielded 18 cases of squamous cell carcinoma and two cases of vaginal intraepithelial neoplasia 3 (VAIN 3). Of these, 3 had been operated on according to the Wharton technique, 8 according to the McIndoe technique, 3 with a split-skin graft vaginoplasty, 2 according to the Davydov technique, 2 with a simple cleavage technique, 1 according to the Vecchietti technique and 1 with a bladder flap vaginoplasty. A total of 17 cases of adenocarcinoma and 1 case of high-grade polypoid dysplasia were also described. Of these, 15 had undergone intestinal vaginoplasty, 1 had been operated on according to the McIndoe technique and 1 had undergone non-surgical vaginoplasty. Finally, 1 case of verrucous carcinoma in a woman who had undergone a split-skin graft vaginoplasty, was reported.

CONCLUSION

Although rare, neovaginal carcinoma is a definite risk after vaginal reconstruction, regardless of the adopted technique. Gynaecologic visits including the speculum examination, the HPV DNA and/or the Pap smear tests should be scheduled on an annual basis.

Development of a mucinous adenocarcinoma on a sigmoid colpoplasty for vaginal agenesis: About a case report and review of the literature

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Our article lists all cases in the neovaginal cancer literature since 1929.

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We propose an explanation of the pathophysiology of the development of neovaginal cancer.

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We propose a classification of neovaginal cancers.

We report a case of mucinous adenocarcinoma developed on sigmoid colpoplasty, performed for a congenital agenesis vaginal. The cancer development of neovagina remains exceptional. Its management consists, in the majority of cases, in surgery for a complete excision. Adjuvant treatments are associated according to the pathological results and the neovagina reconstruction technique performed.

Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review

Objective

To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome.

Materials and methods

A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the follow- ing terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed.

Results

14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compro- mise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction.

Conclusions

Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.

Laparoscopically assisted neovaginoplasty in vaginal agenesis: a long-term outcome study in 240 patients

STUDY OBJECTIVE

To assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis.

DESIGN

Combined retrospective and prospective study.

SETTING

University hospital.

PARTICIPANTS

240 patients with congenital vaginal agenesis.

INTERVENTIONS

Patients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device.

MAIN OUTCOME MEASURES

Long-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections.

RESULTS

During median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intraepithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up.

CONCLUSIONS

Our technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.

Squamous papilloma with hyperpigmentation in the skin graft of the neovagina in Rokitansky syndrome: literature review of benign and malignant lesions of the neovagina

BACKGROUND

It is rare for a benign or malignant neoplasm to develop in a neovagina.

CASE

This is the first report of a squamous papilloma with hyperpigmentation which developed in the neovagina 12 years after a McIndoe procedure was done with a split-thickness skin graft from the patient's buttock. The patient had congenital absence of the vagina and uterus (Rokitansky syndrome, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH syndrome). It presented as post-coital blood spotting for 3 months.

CONCLUSION

As a routine, all cases of vaginal construction regardless of the reason for the surgery or the lining of the neovagina should have a continuous annual examination and careful inspection of the entire vagina. Biopsy of any unusual finding should be done. Despite the dark color of the vaginal lesion, bleeding and rapid appearance our patient had a benign tumor. Radiation therapy to the neovagina and prolonged treatment with podophyllin and cauterization should be avoided.

[Anatomic and histological characteristics of vagina reconstructed by McIndoe method]

BACKGROUND/AIM

Congenital absence of vagina is known from ancient times of Greek. According to the literature data, incidence is 1/4 000 to 1/20 000. Treatment of this anomaly includes non-operative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to establish anatomic and histological characteristics of vagina reconstructed by McIndoe method in Mayer Küster-Rockitansky Hauser (MKRH) syndrome and compare them with normal vagina.

METHODS

The study included 21 patients of 18 and more years with congenital anomaly known as aplasio vaginae within the Mayer Küster-Rockitansky Hauser syndrome. The patients were operated on by the plastic surgeon using the McIndoe method. The study was a retrospective review of the data from the history of the disease, objective and gynecological examination and cytological analysis of native preparations of vaginal stain (Papanicolau). Comparatively, 21 females of 18 and more years with normal vaginas were also studed. All the subjects were divided into the groups R (reconstructed) and C (control) and the subgroups according to age up to 30 years (1 R, 1C), from 30 to 50 (2R, 2C), and over 50 (3R, 3C). Statistical data processing was performed by using the Student's t-test and Mann-Writney U-test. A value of p < 0.05 was considered statistically significant.

RESULTS

The results show that there are differences in the depth and the wideness of reconstructed vagina, but the obtained values are still in the range of normal ones. Cytological differences between a reconstructed and the normal vagina were found.

CONCLUSION

A reconstructed vagina is smaller than the normal one regarding depth and width, but within the range of normal values. A split skin graft used in the reconstruction, keeps its own cytological, i.e. histological and, so, biological characteristics.

[Sensibility of vagina reconstructed by McIndoe method in Mayer-Rokitansky-Küster-Hauser syndrome]

BACKGROUND/AIM

Congenital absence of vagina is a failure present in Mayer-Küster-Rokitansky-Hauser syndrome. Treatment of this anomaly includes nonoperative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to determine sensitivity (touch, warmness, coldness) of a vagina reconstructed by McIndoe method in Mayer-Küster-Rokitansky-Hauser syndrome and compare it with the normal vagina.

METHODS

A total of 21 female persons with reconstructed vagina by McIndoe method and 21 female persons with normal vagina were observed. All female persons were devided into groups and subgroups (according to age). Sensibility to touch, warmness and coldness were examined, applying VonFrey's esthesiometer and termoesthesiometer for warmness and coldness in three regions of vagina (enter, middle wall, bothom). The number of positive answers was registrated by touching the mucosa regions for five seconds, five times.

RESULTS

The obtained results showed that female patients with a reconstructed vagina by McIndoe method, felt touch at the middle part of wall and in the bottom of vagina better than patients with normal one. Also, the first ones felt warmness at the middle part of wall and coldness in the bottom of vagina, better than the patients with normal vagina. Other results showed no difference in sensibility between reconstructed and normal vagina.

CONCLUSION

Various types of sensibility (touch, warmness, coldness) are better or the same in vaginas reconstructed by McIndoe method, in comparison with normal ones. This could be explaned by the fact that skin grafts are capable of recovering sensibility.