RESUMO
BACKGROUND: Squamous cell carcinoma of the vagina in pregnancy is rare. CASE: A 28-year-old primigravida with antepartum bleeding at 20 weeks' gestation was diagnosed with squamous cell carcinoma after biopsy of a vaginal mass. The histology revealed an invasive grade 3 squamous cell carcinoma of large-cell, nonkeratinizing type. The patient declined pregnancy termination and immediate radiation treatment. She continued to have episodes of vaginal bleeding and was admitted at 30 weeks' gestation. A decision was made in consultation with the neonatal unit to deliver her at 32 weeks' gestation. After corticosteroid treatment, she was delivered by cesarean delivery. Positive pelvic lymph nodes were noted at surgery. Postoperatively, she received external beam radiation and brachytherapy and concurrent cisplatin chemotherapy. She is disease free 3 years from her original diagnosis. CONCLUSION: This case emphasizes the importance of a thorough pelvic examination to assess the vaginal walls and cervix at the first prenatal visit and with any antepartum bleeding episode.
Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/terapia , Neoplasias Vaginais/patologia , Neoplasias Vaginais/terapia , Adulto , Braquiterapia , Carcinoma de Células Escamosas/metabolismo , Cisplatino/uso terapêutico , Terapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Metástase Linfática , Gravidez , Complicações Neoplásicas na Gravidez/metabolismo , Dosagem Radioterapêutica , Neoplasias Vaginais/metabolismoRESUMO
BACKGROUND: Endometrial ablation is a surgical alternative to hysterectomy. Cases exist in the literature of endometrial adenocarcinoma found at endometrial ablation. If endometrial cancer is occult it might not be detected during ablation, especially if destructive techniques are used. CASE: A 41-year-old woman had a history of menorrhagia. A previous D&C showed benign proliferative endometrium. Investigations for menorrhagia found no abnormalities. The diagnosis was dysfunctional uterine bleeding. Endometrial ablation was done and the pathologic examination of the resected endometrium found focal, well-differentiated adenocarcinoma of the endometrium. CONCLUSION: This case shows the importance of patient selection, evaluation, and surveillance after endometrial ablation. Resection of the endometrium is superior to destructive techniques because it provides tissue for pathologic evaluation. We recommend close postoperative surveillance in such cases.
