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Rationale: Renal cell carcinoma (RCC) is the most common type of kidney cancer and is the second most common urologic neoplasm. Vaginal metastasis from RCC is extremely rare clinically., Patient Concerns: A 56-year-old woman presented with intermittent vaginal bleeding that had persisted for 1 month. Enhanced computed tomography examination suggested a vaginal mass (3 × 2 × 2 cm), right kidney tumor (15 × 12 × 10 cm), and an inferior vena cava tumor thrombus. During gynecologic examination, the mass was necrotic and caused uncontrollable vaginal bleeding., Diagnoses: Based on clinical and imaging examinations and the pathology, she was diagnosed as vaginal metastasis from RCC., Interventions: The patient received percutaneous transcatheter arterial embolization to stop uncontrollable vaginal bleeding, and then treated with targeted therapy., Outcomes: Vaginal bleeding disappeared after interventional embotherapy. However, disease progressed, and the patient died 9 months later., Lessons: In cases of vaginal bleeding, the possibility of metastatic renal cell carcinoma should be considered. Percutaneous transcatheter arterial embolization is an effective and novel treatment for uncontrollable vaginal bleeding caused by vaginal metastasis of RCC., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

This is a case of a 62-year-old woman with a remote history of acinic cell carcinoma of the parotid gland, who presented with a palpable vaginal mass, anterior vaginal wall prolapse, and stress urinary incontinence. A 2 cm firm mobile mass on the anterior vaginal wall was found on clinical examination. A computed tomographic scan revealed a mass between the vaginal vault and bladder that was eventually surgically excised. The histology, supported by the immunohistochemistry, revealed metastatic acinic cell carcinoma to the vagina after 37 years of her initial diagnosis. This is the first reported case in the literature to occur in the vagina.

Objective: To study the clinicopathologic features of a rare disease of pagetoid urothelial intraepithelial neoplasia (PUIN) in the vulva., Materials and Methods: We reviewed a case of PUIN in a Chinese woman with a long history of bladder urothelial carcinoma., Results: The patient presented with vulvar pruritus for more than 1 month. Gynecologic examination showed a red, thickened, eczematoid lesion in the bilateral labia minora and a palpable 4-cm mass between the middle part of the vagina and the urethral meatus. Microscopically, the neoplastic cells with clear or pale eosinophilic cytoplasm were distributed throughout the squamous epithelium, with a predilection for the middle and basal portion in the vulva. Acantholysis-related papillary formation and pagetoid spread pattern to the normal squamous epithelium were also present. Invasive carcinoma was found underneath the unremarkable squamous epithelium in the vaginal biopsy. Immunohistochemistry demonstrated that these cells were negative for mucin stain, carcinoembryonic antigen, and 34βE12 and were strongly positive for cytokeratins 5/6, 7, 18, 19, and 20., Conclusions: This rare entity of PUIN was associated with metastatic urothelial carcinoma and should be discriminated from vulvar Paget disease and pagetoid squamous cell carcinoma in situ.

Unlabelled: We report a case of a 30-year-old woman with congenital anal cloaca who presented with vaginal bleeding and urinary retention from sigmoid neovagina. She was found to have metastatic mucinous producing adenocarcinoma in the neovagina., Background: Malignancy of neovagina is rare., Summary: We report a case of metastatic colorectal cancer after creation of a neovagina and urethra using sigmoid colon.

Objective: We present an entirely robotic total pelvic exenteration and extended lymphadenectomy with "barreled ureterocutaneostomy" and end colostomy for recurrent endometrial cancer. In 1948, Brunschwig first described a pelvic exenteration as treatment of advanced recurrent malignancy in the pelvis. Currently it represents the only potentially curative option for patients with recurrent endometrial cancer., Methods: A 69-year-old female with perineal recurrence invading urethral and vaginal walls, lower rectum and anal sphincter was the perfect candidate for total pelvic exenteration., Results: Total operative time was 250 minutes, with a console time of 175 minutes. The estimated blood loss was 365 mL., Conclusions: Good oncological results are expected after robotic total pelvic exenteration owing to the accurate, precise dissection and the extension of lymphadenectomy in the narrow space of the deep pelvis similar to robotic prostatectomy and total mesorectal excision.

Adenocarcinomas occurring in the vagina are rare. Their correct classification may be very challenging to both the gynecologist and the pathologist, but it is essential for appropriate therapy. Although most adenocarcinomas in the vagina arise from other sites in the female genital tract, a significant minority reflects metastasis from a colorectal site. We report a very unusual occurrence of an adenocarcinoma that presented as a mass in the vagina protruding through the introitus. It arose in a rectovaginal fistula consequent to chronic Crohn disease, but it did not extend to involve the colonic mucosa. Neither the initial clinical examination nor the pathologic examination suggested the correct diagnosis. We report this case to remind the gynecologists of the potential complications of Crohn disease, and to highlight for the pathologists the difficulty that is often encountered in the correct identification of the source of carcinomas that are found in the vagina.

Epidermotropic metastases from internal malignancies are exceedingly rare. We report a striking example of epidermotropic metastatic carcinoma of the lower female genital tract to the skin of the abdomen and groin. Atypical cells were scattered throughout the epidermis, mimicking Bowen's disease. Focally, islands of atypical squamous cells were also found in the adjacent dermis. Histopathologically, the lesion resembled a primary invasive squamous cell carcinoma. However, the clinical history of a metastatic carcinoma of the genitalia and the clinical presentation with multiple lesions militated against a primary squamous cell carcinoma and favored interpretation of the lesions as epidermotropic metastases.

Objective: Cytologic screening is commonly used in follow-up of women with uterine cancer to detect vaginal recurrence. The study objective was to assess the efficacy and costs associated with Pap tests in routine surveillance of women with uterine cancer., Methods: Medical records and pathology databases identified patients with uterine cancer at one institution from 1990 to 2002. Patients with their cytologic follow-up at our institution were selected for a subset analysis of Pap tests to estimate the number of Paps and associated charges and costs during follow-up., Results: Seven hundred seventeen women were diagnosed with uterine cancer; the mean age was 60.9 years and the median follow-up was 46 months. A total of 36 women had a recurrence in the vagina; 31 (86%) were apparent clinically, and only 5 (14%) were asymptomatic and identified by Pap test. Women with grade 1 tumors had decreased risk of vaginal recurrence, with an odds ratio of 0.186 (95% confidence interval 0.49-0.712) on multivariate analysis (stage and histology were not significant factors for vaginal recurrence). A subset of 435 patients received cytologic follow-up at our institution, with a median 3 Pap tests/patient (mean 4.25, range 1-24). Estimates based on our data demonstrate that 430 Pap tests are required to detect one asymptomatic vaginal recurrence, and the addition of the Pap test increases the cost of surveillance by $15,142 per asymptomatic recurrence detected (but a charge to insurance of $23,487). Pap tests identified an asymptomatic vaginal recurrence in only 0.7% of this uterine cancer population., Conclusion: Pap tests after diagnosis and treatment of uterine cancer infrequently detect asymptomatic vaginal recurrences and may not be cost-effective., Level of Evidence: III.

Patients with advanced vulvovaginal mucosal melanoma generally have a dismal prognosis, and no effective systemic therapy for the disease has been reported. The objective of this retrospective clinical study was to assess the clinical benefit of biochemotherapy in this patient population. We evaluated the medical records of all patients with advanced vulvovaginal mucosal melanoma treated with biochemotherapy at our institution. Our search yielded 11 patients with adequate documentation for study inclusion: eight patients had undergone treatment with cisplatin (CDDP), vinblastine (VB), dacarbazine (DTIC), interferon-alpha (IFN) and interleukin-2 (IL-2), one with CDDP, VB, DTIC and IFN, one with CDDP, temozolomide and IFN, and one with CDDP, VB, DTIC, tamoxifen, IFN and IL-2. All IL-2 treatments were administered intravenously. The median follow-up duration was 10 months (range, 2-44 months). Four patients (36%) showed partial responses, but none showed a complete response. Two patients did not return for follow-up evaluation after the completion of treatment. The median time to disease progression in all 11 patients was 3 months; however, the median time to disease progression in those with a partial response or stable disease was 6 months. One patient was alive at the last documented follow-up visit (51 months). The median overall survival duration from the start of biochemotherapy was 10 months. Biochemotherapy appears to have significant activity against advanced vulvovaginal melanoma, and should be considered as a systemic treatment option for advanced, metastatic, vulvovaginal melanoma.

Vaginal metastases, though more frequent than primary vaginal tumors, are rare. Except for isolated reports of metastatic disease arising from extragenital organs, the vagina is typically a site for metastatic disease from genitourinary tract sites, especially cervix, endometrium, and kidney. We present herein a case of a 68-year-old woman presenting with a vaginal metastasis as the first manifestation of a uterine leiomyosarcoma. The magnetic resonance imaging features are described and correlated with the pathological findings. To the best of our knowledge, this is the first case of vaginal metastasis from uterine leiomyosarcoma described in the literature.

We report the clinicopathologic features of three cases of malignant melanoma metastatic to the vagina; only one similar case has been previously reported. The age of the patients ranged from 33 to 70 years; two presented with vaginal bleeding. Two patients had a history of a previous primary malignant melanoma, one a preauricular melanoma treated 7 years earlier and the other a vulvar melanoma treated 2 years earlier. In the third case, a primary malignant melanoma was found on the sole of the right foot after the patient had presented with the vaginal metastases. On gross examination, the vaginal tumors were polypoid; two were on the posterior wall and one was on the anterior wall. All were of epithelioid cell type and were positive with S-100 and microphthalmia-transcription factor. Tyrosinase was positive in two cases, HMB-45 was positive in one case, and MART-1 was focally positive in one case. One patient underwent wide local excision of tumor followed by chemotherapy, one patient had intracavitary radiotherapy, and one had palliative radiotherapy to the brain only. The patients died after a follow-up of 3, 14, and 48 months.

We describe an epithelioid trophoblastic tumor (ETT) metastatic to the vagina in a 30-year-old Japanese woman. A polypoid tumor in the vaginal orifice was composed of nests of intermediate trophoblastic cells that showed a striking epithelioid appearance. In the hysterectomy specimen, a tumor infiltrated through the myometrium and showed histologic findings similar to those of the vaginal tumor. The tumor cells were positive for cytokeratin, inhibin-alpha, and melanoma cell adhesion molecule (Mel-CAM, CD146) but were only focally positive for human placental lactogen. Electron microscopic examination revealed bundles of well-developed, intermediate-type filaments surrounding the nuclei.

Various malignant neoplasms, either primary or secondary, can affect the vagina. The most common primary malignant tumors of the vagina are squamous cell cancers; however, they are among the most uncommon of all primary gynecologic cancers. Vaginal intraepithelial neoplasia is being diagnosed with increasing frequency and continues to be a challenging problem. Laser therapy and topical 5-fluorouracil are the preferred treatment methods reported in the current literature. Invasive cancer of the vagina is primarily a disease of the older woman and presents most commonly with abnormal bleeding. Radiotherapy continues to be used as external beam or intracavitary treatment for the majority of women with this problem. Vaginal melanomas are a special group of vaginal neoplasms and appear to have a much poorer prognosis than their vulvar counterparts. It would appear that early diagnosis is the most favorable factor affecting outcome, with treatment modality being secondary.

From 1968 to 1974, 540 patients with stage I adenocarcinoma of the corpus uteri entered a prospective clinical trial to evaluate the effect of postoperative external pelvic irradiation. After primary surgery all patients received intravaginal radium irradiation; 6000 rads was delivered to the surface of the vaginal mucosa. At the time vaginal radium was given, randomization was performed: Group A received no further treatment (controls); group B received additional high-voltage irradiation to the pelvic field with a dose of 4000 rads to the pelvic lymph nodes. During the follow-up period of 3 to 10 years a significant reduction in vaginal and pelvic recurrences was found in group B as compared with group A (1.9 versus 6.9%, P < .01). On the other hand, more patients in group B developed distant metastases than those in group A (9.9 versus 5.4%). Thus, the 5-year survival rate was not improved by external irradiation. A more detailed analysis of the series led to the conclusion that only patients with poorly differentiated tumors (grade 3), which infiltrate more than half the myometrial thickness, might benefit from additional external radiotherapy. In almost 20% of 151 consecutive patients, tumor cells were found in endothelial lined spaces. Significantly more deaths and recurrences were found among these patients compared to those without vessel invasion (26.7 versus 9.1%, P < .01).

Three hundred fifty-nine patients with gestational trophoblastic disease (choriocarcinoma and invasive mole) received complete treatment at the Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1978. Data were gathered as of December 31, 1978, to permit a minimum follow-up of 2 years. An overall remission rate of 92% was achieved: 100% (185/185) for nonmetastatic disease and 83% (144/174) for metastatic disease. All 200 patients with invasive mole and 129 of 159 patients (81%) with choriocarcinoma were cured. Chemotherapy was the main form of treatment, with adjuvant surgery and radiation therapy being used in selected patients. Five factors were determined to significantly influence response to treatment in patients with metastatic disease: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (71 versus 100%, P much less than .0005); 2) pretreatment human chorionic gonadotropin titer greater than 100,000 IU/liter and time greater than 4 months from pregnancy event to treatment (62 versus 93%, P much less than .0005); 3) metastases to sites other than lung and/or vagina (37 versus 92%, P much less than .0005); 4) antecedent term gestation compared with hydatidiform mole, abortion, and ectopic pregnancy (56 versus 79%, P less than .02); and 5) prior unsuccessful chemotherapy compared with no previous treatment (48 versus 83%, P much less than .0005). The value of secondary chemotherapy and adjuvant irradiation was evaluated. Relapse from remission was also studied.

Three patient positioning technique have been developed for direct coronal computed tomography (CT) of the body, covering the complete torso: position A, to study pelvis, including retroperitoneal space and lower abdomen; position B, to study upper abdomen and lower chest; and position C, to study upper chest, including neck and posterior fossa. In comparison with multiplanar reformatting (MPR), direct coronal CT has three basic advantages: (a) image quality is improved as a result of a lack of partial volume averaging and patient motion disturbance; (b) the direct coronal planes can be truly parallel to the spinal axis, due to stretching of the lordotic segments of the spine; and (c) examination time is reduced, since a large number of overlapping slices and time consuming MPR effort are not required. Direct coronal CT of the body has been carried out in more than 600 cases and was often uniquely informative. In our institution, use of MPR CT is now restricted to small volumes and/or disabled patients.