Primary vaginal carcinoma

Last revised by Dr Mohamed Saber on 23 Dec 2020

Primary vaginal carcinoma, although being a rare overall, is still the 5th commonest gynecological malignancy. A primary vaginal carcinoma is defined as a neoplasm that arises solely from the vagina with no involvement of the external os superiorly or the vulva inferiorly, the importance of this definition lying in the fact that the most of malignancies involving the vagina are due to invasion from nearby tumors and the different clinical approaches in the treatment of cervical carcinoma and vulval carcinoma.

It can account for 1-3% of all gynecologic malignancies. The typical age at presentation is at around the 6th to 7th decades of life.

Lesions characteristically arise from the posterior wall of the upper third of the vagina. The common patterns of disease are:

  • an ulcerating or fungating mass or 
  • an annular constricting lesion

Imaging features will somewhat depend on the histologcial type of malignancy. 

Reported general signal characteristics in general include 6:

  • T1: isointense to muscle
  • T2: high signal intensity compared with muscle

Reported signal charactersitics for squamous cell carcinoma include 1:

  • T1: low signal intensity
  • T2: intermediate signal intensity

See: vaginal cancer staging

Prognosis is significantly dependent on stage. Carcinoma in situ and very early stage invasive carcinoma is often treated with surgery. However, the standard therapeutic intervention for patients with carcinoma of the vagina is radiation therapy. Advanced stages are often treated with radiography and chemotherapy (e.g. Cisplatin)

For large lesions consider invasion of the vagina by:

Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.

Other differential considerations include:

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Cases and figures

  • Case 1: squamous cell carcinoma
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  • Case 2: pleomorphic leiomyosarcoma
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