Primary vaginal carcinoma, although being a rare overall, is still the 5th commonest gynaecological 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 tumours and the different clinical approaches in the treatment of cervical carcinoma and vulval carcinoma.
It can account for 1-3% of all gynaecologic 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
- squamous cell carcinoma of the vagina: by far the commonest accounts for ~80-85% of primary vaginal malignancies, presents in older individuals
adenocarcinoma of the vagina: ~15% second commonest subtype, presents in younger individuals and arising from vaginal adenosis
- clear cell carcinoma of the vagina: rare, previous diethylstilbestrol (DES) exposure
- primary vaginal melanoma
vaginal sarcoma: rhabdomyosarcoma in paediatric population
- botryoid rhabdomyosarcoma
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
Treatment and prognosis
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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- 8. Tardivon AA, Kinkel K, Lartigau E et-al. MR imaging during intracavitary brachytherapy of vaginal and cervical cancer: preliminary results. Radiographics. 1996;16 (6): 1363-70. Radiographics (abstract) - Pubmed citation
- 9. FRCPath VKMBBSMD, MBBS AKA, Aster JC. Robbins Basic Pathology. Saunders. (2012) ISBN:1437717810. Read it at Google Books - Find it at Amazon