Nadir bir olgu sunumu: Total uterin prolapsus zemininde gelişen vajinal karsinoma olgusu
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Tarih
2023
Yazarlar
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T.C.Maltepe Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Vajinal kanserler 100.000 kadında 0,42 insidans ile jinekolojik malignitelerin %1- 2'sini oluşturur ve bunların %80-90 kadarı metastatiktir (1,2). Etiyolojiden primer olarak Human Papilloma virus (HPV) sorumludur. En sık görülen semptomları ağrısız vajinal kanama ve akıntıdır (2). Evreleme klinik olarak yapılır. Genital prolapsus ile birlikte görülen vajinal karsinom oldukça nadirdir. Literatürde bildirilen çok az sayıda vaka mevcuttur (3,4). Genital prolapsus olgularmda hasta genellikle ülseratif lezyon ile karşımıza çıkar. Bu ülserelere kronik irritasyon ve inflamasyonun neden olduğuna inanılır. Bizim vakamızda da 82 yaşmda total uterin prolapsus zemininde gelişmiş vajinal kanser olgusunu sunacağız. Olgu: Postmenopozal, 82 yaşında, multipar (Gravida 5, parite 5) hasta 15 gündür olan vajinal kanama şikâyetinin artması üzerine acilden kliniğimize başvurdu. Düzenli jinekolojik takibi olmayan hastanın 6 yıldır uterin prolapsus öyküsü, 2 yıldır Pesser kullanım öyküsü olduğu; ancak son 6 aydır prolapsusunun irredüktabl olduğu ve üzerinde ülsere lezyon geliştiği öğrenildi. Hastanın medikal özgeçmişinde kalp yetmezliği öyküsü nedeniyle ilaç kullanımı mevcut idi. Cerrahi özgeçmişinde total kalça replasmanı mevcut idi. Aile öyküsünde bir özellik saptanmadı. Hastanın yapılan pelvik muayenesinde total uterin prolapsus saptandı. Vajen sol ön duvar kaynaklı 5-6 cm çapmda, serviksten 3cm uzaklıkta, vejetatif yapıda ülsere lezyon saptanması üzerine lezyondan eksizyonel biyopsi alındı. Histopatolojik inceleme neticesi skuamöz hücreli karsinom saptandı. Rektal muayenede özellik saptanmadı. Hastanın yapılan ayakta direk batın grafisi, abdominal ultrason, sistoskopi, kolonoskopi incelemelerinde patolojik bulguya rastlanmadı. Hasta klinik olarak evre 1 vajina karsinomu olarak evrelendirilmesi ve irredüktabl uterin prolapsus saptanması üzerine genel anestezi altında radikal vajinal histerektomi ve 2/3 üst vajinektomi uygulandı. Postoperatif dönemde herhangi bir komplikasyon gelişmedi. Cerrahi sonrasındaki nihai histopatoloji raporu, vajina duvarında grade 1 skuamöz hücreli karsinom FIGO evre 1 olarak bildirildi. Cerrahi sınırlar intakt idi, lenfatik invazyon mevcut değil idi. Hasta postoperatif dönemde toplamda 5600 cGy eksternal radyoterapi tedavisi aldı. Radyoterapi seanslarının tamamlanmasının ardından 1 yıl boyunca 3 aylık aralıklarla yapılan kontrol pelvik muayenelerinde patolojik bulguya rastlanmadı. Birinci yılın sonunda yapılan kontrol görüntülemelerinde rekürrens veya metastaz lehine bulguya rastlanmadı. Sonuç: Genital prolapsuslarda erezyon sık rastlanılan bulgu olmasma karşm bu zeminde kanser gelişmesi oldukça nadir görülen bir durumdur. Hastanın tedavisini planlamadan önce bu lezyonlardan biyopsi almaması olası eksik veya yetersiz tedavi seçiminin önüne geçecektir.
Introduction: Vaginal cancers constitute 1-2% of all gynecological malignancies with an incidence of 0.42 per 100,000 women, and 80-90% of them are metastatic. Human Papilloma virus (HPV) is primarily an etiologic agent for vaginal cancers. The most common symptoms are painless vaginal bleeding and discharge. Staging is done clinically. Vaginal carcinoma presenting with genital prolapse is extremely rare. There are very few cases reported in the literature. In genital prolapse cases, the patient usually presents with an ulcerative lesion. These ulcers are generally caused by chronic irritation and inflammation. In this case, we presented a case of vaginal cancer developed based on total uterine prolapse in an 82-year-old female patient. Case: A postmenopausal, 82-year-old, multiparous (Gravida 5, Para 5) patient was admitted to our emergency clinic due to the increase in vaginal bleeding for 15 days. The patient, who did not have a regular gynecological follow-up, had a history of uterine prolapse for 6 years and using Pesser for 2 years; however, her prolapse was irreducible for the last 6 months and an ulcerated lesion developed on it. There were heart failure and total hip replacement in her medical history. No feature was found in the family history. Total uterine prolapse was detected in the pelvic examination of the patient. Rectal examination was normal. Excisional biopsy was taken due to the detection of a vegetative ulcerated lesion originating from the left anterior wall of the vagina, 5-6 cm in diameter, and 3 cm away from the cervix. Histopathological examination revealed squamous cell carcinoma. No pathological findings were found in the abdominal X-ray, abdominal ultrasound, cystoscopy, and colonoscopy. After the patient was clinically staged as stage 1 vaginal carcinoma, radical vaginal hysterectomy and 2/3 upper vaginectomy were performed. No complications developed in the postoperative period. The final histopathology report after surgery was reported as grade 1 squamous cell carcinoma FIGO stage 1 in the vaginal wall. Surgical borders were negative and there was no lymphatic invasion. The patient received a total of 5600 cGy external radiotherapy treatment in the postoperative period. After the completion of the radiotherapy sessions, no pathological findings were found in the control pelvic examinations performed at 3-month intervals for 1 year. In the first-year follow-up visit, there were no findings of recurrence or metastasis in control imaging methods. Conclusion: Although erosion is a common finding in genital prolapses, the development of cancer on this background is a very rare condition. Biopsy of these lesions before planning the treatment of the patient will prevent possible incomplete or inadequate treatment.
Introduction: Vaginal cancers constitute 1-2% of all gynecological malignancies with an incidence of 0.42 per 100,000 women, and 80-90% of them are metastatic. Human Papilloma virus (HPV) is primarily an etiologic agent for vaginal cancers. The most common symptoms are painless vaginal bleeding and discharge. Staging is done clinically. Vaginal carcinoma presenting with genital prolapse is extremely rare. There are very few cases reported in the literature. In genital prolapse cases, the patient usually presents with an ulcerative lesion. These ulcers are generally caused by chronic irritation and inflammation. In this case, we presented a case of vaginal cancer developed based on total uterine prolapse in an 82-year-old female patient. Case: A postmenopausal, 82-year-old, multiparous (Gravida 5, Para 5) patient was admitted to our emergency clinic due to the increase in vaginal bleeding for 15 days. The patient, who did not have a regular gynecological follow-up, had a history of uterine prolapse for 6 years and using Pesser for 2 years; however, her prolapse was irreducible for the last 6 months and an ulcerated lesion developed on it. There were heart failure and total hip replacement in her medical history. No feature was found in the family history. Total uterine prolapse was detected in the pelvic examination of the patient. Rectal examination was normal. Excisional biopsy was taken due to the detection of a vegetative ulcerated lesion originating from the left anterior wall of the vagina, 5-6 cm in diameter, and 3 cm away from the cervix. Histopathological examination revealed squamous cell carcinoma. No pathological findings were found in the abdominal X-ray, abdominal ultrasound, cystoscopy, and colonoscopy. After the patient was clinically staged as stage 1 vaginal carcinoma, radical vaginal hysterectomy and 2/3 upper vaginectomy were performed. No complications developed in the postoperative period. The final histopathology report after surgery was reported as grade 1 squamous cell carcinoma FIGO stage 1 in the vaginal wall. Surgical borders were negative and there was no lymphatic invasion. The patient received a total of 5600 cGy external radiotherapy treatment in the postoperative period. After the completion of the radiotherapy sessions, no pathological findings were found in the control pelvic examinations performed at 3-month intervals for 1 year. In the first-year follow-up visit, there were no findings of recurrence or metastasis in control imaging methods. Conclusion: Although erosion is a common finding in genital prolapses, the development of cancer on this background is a very rare condition. Biopsy of these lesions before planning the treatment of the patient will prevent possible incomplete or inadequate treatment.
Açıklama
Anahtar Kelimeler
Total uterin prolapsus, Vajinal karsinom, Vajinektomi, Total uterine prolapse, Vaginal carsinoma, Vaginectomy
Kaynak
EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Atasayan, K. (2023). Nadir bir olgu sunumu: Total uterin prolapsus zemininde gelişen vajinal karsinoma olgusu, Akgün, Feride Sinem, (ed.). EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days; İstanbul: T.C.Maltepe Üniversitesi. s.77-82.
