Download Tumour of the vagina

Tumor of the vagina
1- Swellings of the vagina
2- Vaginal cyst
3-Benign Neoplasms
4- Malignant Neoplasms
SWELLING OF THE VAGINA
A complaint of swelling or fullness in the vagina
May be caused by the following :
-Retained fluid – heamatocolpos , pyocolpos
-prolapse of the vaginal wall or uterus
-A congenitally short vagina with a relatively low
cervix .
-Varicose veins which are usually low on the
anterior wall and are mostly seen during pregnancy
-Tumor of the urethra
Enlargement of the cervix Any tumor which impacted within the pelvis
Vaginal cysts
Benign neoplasms
Malignant neoplasms
VAGINAL CYSTS
Since the vaginal epithelium is
normally devoid of glands, most
cysts arise from included or
adjacent structures . Their nature
and origin are therefore
determined clinically by their
position
A- cysts of vestigial structures
--- Mullerian :
a- single
b- multiple
Lined by tissue similar to that of the cervical
epithelium and containing mucinous material,
sometimes occur near the cervix .
They are from displaced cervical glands or from
mullerian duct diverticula and their
remnants.
-- Wolffian
Their lining is a single layer of flattenend
columnar or cuboidal epithlium, but can be
transitional, their fluid content is free from
mucine. The majority arise from Gartner s duct
---- Cysts of Skene s Tubules (Parauretheral )
Maybe infected to cause a paraurethral abscess
----- Diverticulum of the urethra ,it is either
. Congental
. abscess or periurethral glands which burst
into the urethra
. Obstetrical or surgical injuries
--- Epidermoid Cyst; Implantaton Dermoid •
Endometrotic cyst •
BENINGN NEOPLASMS
Papilloma:
True papillomas (including multiple warts)
Most tumor of this type are skin tags remaining from
obstetrical injuries or operations.
Angioma:
is a congenital malformation of the blood vessels
usually seen under the lateral walls.
Fibroma and Lipoma:
These arise from the outer coats of the vagina or from
the paracolpos. .
Adenoma:
this is a rare tumor arises in association with
Gartner s duct and has therefor anterolateral
sites.
Adenosis: it is result from faulty diffrerentoation
or distribution of mullerian duct tissue during
the development of the vagina.One of the caus
is exposure to diethylstillbesterol
1-it very unusual condition in which columner
epithlium, sometimes multi- layered replaces
the squmous lining.
2- patchy distribution
3- the area dull red granulomatous appearance
and failing to stain with Lugosl solutionor
Schiller s iodine
4- the epithelial cells secretes mucus
Diagnosis usually in adolescence or early
maturity, it is sometimes associated with minor
degree of vaginal stricture formation, just below
the level of the cervix . There is a chance to run
to a clear cell adenocacinoma ,
Vaginal cancer
Primary vaginal CA represent 2% to3% of
malignant neoplasms of the female genital tract
And squamous cell CA REPRESENT 80% OF
cases.
84% of Vaginal CA were secondary
32% from the cervix
18%fom the endometrium
9% from colon and rectum
6% from the ovary
6%from the vulva
Squamous cell ca
Women who have been treated for a
prior anogential cancer , particularly of
the cervix, have a high relative risk of
developing vaginal cancer, and 30% of
patients with primary vaginal
carcinoma have a history of in situ or
invasive cervical cancer treated at least
5 years earlier
There are three possible mechanisms for the
occurrence of vaginal cancer after cervical
neoplasia:
1- occult residual disease
2-new primary disease arising in an “at risk “
lower genital tract
3- radiation carcinogcity
There is controversy regarding the distinction
between a new primary vaginal cancer and
recurrent cervical cancer . Many authorities use
a 5 years cut-off because 95%CA of cervix will
recur within this period , but other prefer a 10year interval. The true malignant potential of
vaginal intraepithelial neoplasia is unclear
because once diagnose , the condition is treated
Chronic local irritation from long – term use of
apessary may also be of significance . Most lesion
are situated in the upper one- third of the vagina ,
usually at the apex or on the posteror wall
Diagnosis:
The diagnosis of carcinoma of the vagina is often
missed on first examination, particularly if the
lesion is small and situated in the lower two-thirds
of the vagina,where it may be covered by the
blades of the speculum. In patients with an
abnormal Pap smear and no gross abnormality ,
careful vaginal colposcopy and the liberal use of
Lugol s iodine to stain the vagina are necessary.
For definitive diagnosis of early vaginal carcinoma,
it may be necessary to resect the entire vaginal
vault and submit it for carful histologic evaluation
because the lesion may be partially buried by
closure of the vaginal at the time of hysterectomy
Symptoms and Sign:
1- painless vaginal bleeding and discharge
is usually postmenopausal but may be
postcoital
2- bladder pain and frequancy of micturition
Staging
Stage I: The carcinoma is limited to the vaginal wall
Stage II: The carcinoma has involved the subvaginal
tissue but has not extended to the pelvic wall.
Stage III : The carcinoma has extended to the pelvic
wall.
Stage IV :The carcinoma has extended beyond the
true pelvis or has involved the mucosa of the
bladder or rectum
IVA: Tumor invades bladder and/or rectal mucosa
and/or direct extension beyond the true pelvis
IVB: Spread to distant organs
Surgical staging for vaginal cancer has
been used less commonly than for
cervical cancer, but in selected
premenopausal patients , a
pretreatment laparotomy may allow
better definition of the extent of
disease, excision of any grossly
enlarged lymph nodes , and placement
of an ovary up into the paracolic gutter
beyond the radiation field
Patterns of spread
1- Direct extension
2- lymphatic
dissemination
3-heamatogenous
dissemination
Treatment
Therapy must be individualized and varies
depending on the stage of the disease and the
site of vaginal involvement , further limiting
individual experience. For most patients,
maintenance of functional vagina is an
important factor in the planning of therapy
1-Surgery
It has limited role in the management of
patients with vaginal cancer
a – in patient with stage I disease involving the
upper posterior vagina. If the uterus still in situ,
these patients require radical hysterectomy ,
partial vaginectomy ,and bilateral
lymphadenectomy
If the patient has hysterectomy , radical upper
vaginectomy and pelvic lymphadenectomy .
b- In young patient who require radiation
therapy. Pretreatment laparotomy in such
patient may allow ovarian transposition, surgical
staging , and resection of any enlarge lymph
node .
c- In patient with stage IVA disease ,particularly
if a rectovaginal or vesicovaginal fistula is
present , pelvic exenteration is a suitable
treatment
2- Radiation Therapy
It is the treatment of choice for all patients
except those listed previously .
If the lower 1/3 of the vagina is involved, the
groin nodes should be treated or dissected