Fertility sparing approach to vaginal clear cell adenocarcinoma: a case report

Abstract

Introduction: Four to nine percent of vaginal adenocarcinomas are clear cell adenocarcinomas. The most frequently used therapeutic approach for Stage I vaginal clear cell carcinoma is partial or total vaginectomy combined with radical hysterectomy and pelvic lymphadenectomy. Radical trachelectomy has also become a preferred treatment modality in recent years especially for patients who wish to retain fertility. Case: A 22-year-old nulligravid women was presented to hospital with the complaint of infertility. Gynecological examination revealed two eccentric masses extending from proximal part of the anterior vaginal wall with a diameter of 0.5 cm and 0.5 cm. Histopathological evaluation resulted as clear cell adenocarcinoma. Positron emission tomography/computed tomography (PET/CT) and abdominopelvic magnetic resonance imaging (MRI) revealed no pathologic lymph node involvement and metastatic lesion. Patient was diagnosed as vaginal clear cell adenocarcinoma, FIGO Stage 1, T1N0M0. The patient was informed about each treatment option and patient was scheduled for radical abdominal trachelectomy and lymph node dissection. Frozen section procedure of bilateral pelvic lymph nodes were consistent with the absence of metastasis. Then a radical abdominal trachelectomy was performed. Definitive pathology revealed clear cell adenocarcinoma of the vagina. no pelvic lymph nodes involvement, and negative surgical margins. Adjuvant treatment was not needed. Patient has been followed up every three months by vaginal and cervical smear for 30 months. Postoperative 30th month control revealed no pathologic findings and patient had been menstruating regulary. Conclusion: Strict treatment guidelines however, cannot be formulated and optimal therapeutic approaches must be individualized; radical trachelectomy is a potential fertility sparing procedure described for early stage clear cell carcinoma.