Squamous cell carcinoma is the most common form, second most common form adenocarcinoma both are associated with HPV infection.
| Risk factors similar to cervical | • Age >60 • Human papillomavirus infection • Tobacco use • In utero DES exposure (clear cell adenocarcinoma only) | | --- | --- | | Clinical features | • Vaginal bleeding • Malodorous vaginal discharge • Irregular vaginal lesion ( ex ulcer) | | Diagnosis | • Numerous squamous epithelial cells with rare leukocytes are seen on wet mount microscopy. Potassium hydroxide test is negative. • Vaginal biopsy | | Management | • Surgery ± chemoradiation |
Lesions typically appear as an irregular plaque or ulcer located in the upper third of the posterior vagina.
Additional clinical features may include pelvic pain, urinary symptoms (eg, hematuria), and bulk symptoms (eg, constipation), which are suggestive of metastatic disease
biopsy evaluates the depth of invasion of atypical cells and differentiates between vaginal intraepithelial neoplasia (ie, noninvasive) and vaginal cancer (ie, invasive).
Patients with noninvasive disease can be treated conservatively with topical therapy or a wide local excision In contrast, those with invasive disease require an extensive procedure (ie, radical hysterectomy, vaginectomy, pelvic lymph node dissection) and/or chemoradiation.
As with cervical cancer, vaginal cancer is due to persistent human papillomavirus (HPV) infection with high-risk types 16 and 18. Chronic tobacco use decreases the immune response and prevents viral clearing. This increases the risk of persistent HPV infection and thereby allows continued viral replication and eventual metaplastic changes within the vaginal squamous cell epithelium.
Diethylstilbestrol was previously used for spontaneous abortion prevention in the 1940s. In 1971, DES was discontinued because studies found that it is a potent transplacental carcinoge due to multiple adverse effects (eg, infertility due to anatomic defects). Women who were exposed to this medication in utero are at increased risk of vaginal clear cell adenocarcinoma, not squamous cell carcinoma. DES also has a carcinogenic effect on the mothers who received DES during their pregnancy and has been associated with an increased risk of breast cancer. In Clear adenocarcinoma Pelvic examination shows multiple red, fleshy polypoid masses on the anterior vaginal wall. A biopsy is obtained and histology shows large cells with abundant clear cytoplasm
(Choice B) Human papillomavirus (HPV) infection is the main causative factor for vaginal squamous cell cancer. HPV is also considered a risk factor for adenocarcinoma. Given this patient's history of multiple sexual partners and inconsistent use of condoms, she is likely to have an HPV infection. However, biopsy confirmed that this patient has vaginal clear cell adenocarcinoma, which is a rare subtype of adenocarcinoma that is primarily associated with another risk factor.