Department of Pathology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Int J Gynecol Pathol. 2010 Mar;29(2):193-6. doi: 10.1097/PGP.0b013e3181b6a7d7.
We present a case of a 45-year-old woman with a long-standing history of persistent cervical dysplasia that resulted in a hysterectomy. Subsequent vaginal smears revealed high-grade vaginal intraepithelial neoplasia (VAIN III) on Pap smear with positive human papilloma virus (HPV) testing. Over the course of 2 years, the patient underwent 2 CO(2) laser vaporization procedures of the upper vagina and intermittent 5-fluorouracil therapy. A biopsy performed at the time of the second laser procedure revealed endocervical-type well-differentiated adenocarcinoma, associated with VAIN III. HPV in situ hybridization for HPV types 16 and 18 was positive in both the glandular and squamous mucosa. The patient has no known history of intrauterine diethylstilbestrol exposure or mullerian developmental abnormalities. Subsequently, the patient underwent a radical upper vaginetcomy with bilateral pelvic lymph nodes dissection and bilateral salpingo-oophorectomy. The vaginectomy specimen showed residual adenocarcinoma associated with VAIN-III and extensive vaginal adenosis with free resection margins. This is the second reported case in the literature of adenocarcinoma arising in vaginal adenosis after 5-fluorouracil. Herein, we highlight these important findings and shed some light on the pathogenesis of vaginal adenosis and the subsequent development of vaginal adenocarcinoma.
我们报告了一例 45 岁女性，其长期存在持续性宫颈发育不良，最终导致子宫切除术。随后的阴道涂片检查显示巴氏涂片检查显示高级别阴道上皮内瘤变（VAIN III），人乳头瘤病毒（HPV）检测阳性。在 2 年的时间里，患者接受了 2 次阴道上段二氧化碳（CO2）激光汽化术和间歇性 5-氟尿嘧啶治疗。第二次激光治疗时进行的活检显示宫颈型分化良好的腺癌，伴有 VAIN III。在腺上皮和鳞状黏膜中，HPV 原位杂交均显示 HPV 16 和 18 型阳性。患者无宫内己烯雌酚暴露或苗勒氏发育异常的已知病史。随后，患者接受了根治性阴道上段切除术、双侧盆腔淋巴结清扫术和双侧输卵管卵巢切除术。阴道切除术标本显示与 VAIN-III 相关的残留腺癌和广泛的阴道腺病，切缘无肿瘤残留。这是文献中第二例 5-氟尿嘧啶治疗后阴道腺病继发腺癌的报道。在此，我们强调这些重要发现，并探讨阴道腺病的发病机制以及随后阴道腺癌的发生。
