Recurrence of vaginal implantation of transitional cell carcinoma of the urinary tract.

BACKGROUND

Vaginal recurrence of bladder carcinoma is extremely rare, with only two cases already reported. We have experienced a third case with the same characteristics of the first one, which was a vaginal recurrence with a prior resected urothelial vaginal tumor.

CASE

An 82-year-old woman first presented in 1994 with frequency and gross hematuria. Cystoscopic evaluation revealed a single superficial tumor of the bladder which was treated by endoscopic resection. During the following 7 years, she underwent endoscopic procedures to remove recurrent Ta G2 tumor. In 2002, a cystoscopy revealed a papillary lesion, and a physical examination demonstrated multiple papillary lesion on the vaginal wall. Histology of excised genital lesions showed a Grade 2 transitional cell carcinoma. Two years later, the patient presented with a 1-cm solitary lesion on the right vaginal wall, which was then excised. Histological examination showed high-grade transitional cell carcinoma, infiltrating the chorion of the vagina.

CONCLUSION

Implantation of shed tumor cells in tissues during micturition or resection seems the only plausible cause of the first implantation. For the second recurrence in the vagina, the possibility is of an incomplete locally excision or a relapse, tied to lymphatic micro metastasis, due to involvement of its own lamina propia.