Aggressive Behavior of Warty Squamous Cell Carcinoma of the Vagina Associated with Uterine Prolapsed: Unusual Report

Abstract

Warty squamous cell carcinoma (WSCC), is a rare variant of squamous cell carcinoma that occurs mostly in younger women, but can occur in old women. It is due to human papillomavirus (HPV) infection. This rare entity has been described in several organs such as vulva, cervix, and penis. To the best of our knowledge WSCC of vagina associated with the third-degree of uterine prolapse has never been reported in the literature. We present an exceptional case of WSCC of vagina occurred in a 77-year-old woman with long disease duration. The physical exam found a large ulcer-budding lesion of the middle and lower third of the vagina that depends on the left vaginal wall. The full work-up concluded to stage IVA of FIGO classification, due to the bladder involvement. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic node dissection, left partial cystectomy with left ureteral reimplantation and total vaginectomy, followed by adjuvant radiotherapy. The patient had no recurrence during 8 years of regular follow-up. WSCC can express locally aggressive behavior, such we reported; despite it appears to be less aggressive than the typical well-differentiated squamous cell carcinoma. That leads to individualize WSCC from other verruciform neoplasms.

Keywords: Wart; prolapse; squamous cell carcinoma; uterus; vagina.

Figure 1.

This lesion is associated with a warty surface and low-power architecture analogous to a condyloma lesion (hematoxylin and eosin; original magnification: ×20).

Figure 2.

Papillary vegetations on contiguous surfaces supported by fibrovascular axes (hematoxylin and eosin; original magnification: ×50).

Figure 3.

Cells displaying changes analogous to koilocythic atypia characterize the tumor (hematoxylin and eosin; original magnification: ×40).

Figure 4.

Large, wrinkled cells, with hyperchromatic nuclei and koilocytosis, presence of horn pearl and a deep stromal invasion (yellow asterisk) (hematoxylin and eosin; original magnification: ×50).