A case of vaginal clear cell adenocarcinoma with congenital malformation of the urogenital tract

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  • TANAKA Ayaka
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • YOSHIMURA Akihiko
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • KOIZUMI Kaori
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • NAKAMURA Koji
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • WATANABE Keiko
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • SHIMAZU Miki
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • NAKATSUJI Yuki
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • MASUHARA Kanji
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital
  • NOBUNAGA Toshikatsu
    Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital

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Other Title
  • 泌尿生殖器の先天奇形を合併した腟明細胞腺癌の1例
  • 症例報告 泌尿生殖器の先天奇形を合併した膣明細胞腺癌の1例
  • ショウレイ ホウコク ヒニョウ セイショクキ ノ センテン キケイ オ ガッペイ シタ チツアキラ サイボウセンガン ノ 1レイ

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Abstract

A primary vaginal clear cell adenocarcinoma (CCA) is rare among gynecologic malignancies and generally occurs in young women with prenatal exposure to diethylstilbestrol (DES). We report a rare case of primary vaginal CCA in a 60-year-old female who had not been exposed to DES in utero, along with congenital malformation of the genitourinary tract resulting in left renal agenesis and uterus didelphys. The patient had experienced genital bleeding for the previous two years and lower abdominal pain. A physical examination showed a 5 cm tumor in the left anterior wall of the upper vagina and biopsy findings revealed a CCA. Radiological results indicated FIGO stageII vaginal cancer with congenital anomalies, including uterus didelphys and left renal agenesis. She was treated with a combination of brachytherapy and external-beam radiotherapy. Although MRI showed complete disappearance of the tumor, the patient developed multiple lung metastases seven years after radiation therapy, and received combination chemotherapy with irinotecan and cisplatin (CPT-P). Primary vaginal CCA without DES exposure is extremely rare, though there are several reports noting this type of carcinoma in conjunction with congenital malformation of the urogenital tract. Previous studies have speculated that vaginal adenosis is induced in association with Müllerian duct anomalies, which may provide a basis for carcinogenesis. It is important to perform careful examinations of patients with urogenital malformation. Based on the stage and tumor size in this case, and poor prognosis of affected patients, we speculate that there is room to consider the necessity of multidisciplinary treatments including chemotherapy in addition to irradiation. [Adv Obstet Gynecol, 65(1) : 20-25 , 2013 (H25.2)]

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