Primary intestinal type adenocarcinoma of the female genital tract, arisen from a tubulo-villous adenoma: Case report
A 68-year-old Caucasian woman, Gravida 5 Para 3 Abortus 2, suffered from purulent vaginal discharge. Surgical history: appendectomy. Physical examination revealed a painful and hard nodule of 1 × 1.3 cm at the posterior border of the introitus of the vagina, without signs of infection. Cervical cytology showed no evidence for intraepithelial lesion or malignancy. Transvaginal ultrasound showed a normal uterus and ovaries, no free fluid was seen in the abdomen. The vaginal nodule was excised and examined microscopically. It revealed an invasive adenocarcinoma of the intestinal type arisen from a tubulo-villous adenoma (). There was no evidence of lympho-vascular invasion. Immunohistochemical evaluation showed strong positivity for CEA, CK20 and CK7. There was no expression of estrogen or progesterone receptors and there was no increased expression of P53. Further clinical examination, chest X-ray, mammography, colonoscopy, PET-CT and CEA level excluded the presence of an adenocarcinoma of another location. The suspicion of this lesion to be a primary vaginal adenocarcinoma of the intestinal type was confirmed. The patient underwent a partial vulvectomy. Microscopic investigation of the resection piece showed no residual tumor. The postoperative recovery was complicated by a urinary tract infection, which was treated. The patient was discussed at the multidisciplinary oncological board, which advised a close follow-up. The patient is still disease free after 25 months follow-up.