Tumor of the vagina

Swellings of the vagina -1

Vaginal cyst -2

Benign Neoplasms-3

Malignant Neoplasms -4
 SWELLING OF THE VAGINA
A complaint of swelling or fullness in the vagina
: May be caused by the following
Retained fluid – heamatocolpos , pyocolpos-
prolapse of the vaginal wall or uterus-
A congenitally short vagina with a relatively low-
. cervix
Varicose veins which are usually low on the-
anterior wall and are mostly seen during pregnancy
Tumor of the urethra-
Enlargement of the cervix -
Any tumor which impacted within the pelvis
Vaginal cysts
Benign neoplasms
Malignant neoplasms
 VAGINAL CYSTS
Since the vaginal epithelium is
normally devoid of glands, most
cysts arise from included or
adjacent structures . Their nature
and origin are therefore
determined clinically by their
position
A- cysts of vestigial structures
: Mullerian ---
a- single
b- multiple
Lined by tissue similar to that of the cervical
epithelium and containing mucinous material,
. sometimes occur near the cervix
They are from displaced cervical glands or from
.mullerian duct diverticula and their remnants
Wolffian --
Their lining is a single layer of
flattenend columnar or cuboidal epithlium, but
can be transitional, their fluid content is free
from mucine. The majority arise from Gartner s
duct
Cysts of Skene s Tubules (Parauretheral ) ----
Maybe infected to cause a paraurethral abscess
Diverticulum of the urethra ,it is either -----
Congental .
abscess or periurethral glands which burst into .
the urethra
Obstetrical or surgical injuries .
Epidermoid Cyst; Implantaton Dermoid --- •

Endometrotic cyst •
 BENINGN NEOPLASMS
:Papilloma
True papillomas (including multiple warts)
Most tumor of this type are skin tags remaining from
.obstetrical injuries or operations
:Angioma
is a congenital malformation of the blood vessels usually
.seen under the lateral walls
:Fibroma and Lipoma
These arise from the outer coats of the vagina or from the
. .paracolpos
:Adenoma
this is a rare tumor arises in association with
.Gartner s duct and has therefor anterolateral sites
Adenosis: it is result from faulty diffrerentoation
or distribution of mullerian duct tissue during the
development of the vagina.One of the caus is
exposure to diethylstillbesterol
it very unusual condition in which columner-1
epithlium, sometimes multi- layered replaces the
.squmous lining
patchy distribution -2
the area dull red granulomatous appearance -3
and failing to stain with Lugosl solutionor
Schiller s iodine
the epithelial cells secretes mucus -4
Diagnosis usually in adolescence or early
maturity, it is sometimes associated with minor
degree of vaginal stricture formation, just below
the level of the cervix . There is a chance to run
, to a clear cell adenocacinoma
 Vaginal cancer
Primary vaginal CA represent 2% to3% of
malignant neoplasms of the female genital tract
.And squamous cell CA REPRESENT 80% OF cases
of Vaginal CA were secondary 84%
from the cervix 32%
18%fom the endometrium
from colon and rectum 9%
from the ovary 6%
6%from the vulva
 Squamous cell ca
Women who have been treated for a prior
anogential cancer , particularly of the
cervix, have a high relative risk of
developing vaginal cancer, and 30% of
patients with primary vaginal carcinoma
have a history of in situ or invasive cervical
cancer treated at least 5 years earlier
There are three possible mechanisms for the
occurrence of vaginal cancer after cervical
:neoplasia
occult residual disease -1
new primary disease arising in an “at risk “-2
lower genital tract
radiation carcinogcity -3
There is controversy regarding the distinction
between a new primary vaginal cancer and
recurrent cervical cancer . Many authorities use
a 5 years cut-off because 95%CA of cervix will
recur within this period , but other prefer a 10-
year interval. The true malignant potential of
vaginal intraepithelial neoplasia is unclear
because once diagnose , the condition is treated
Chronic local irritation from long – term use of
apessary may also be of significance . Most lesion
are situated in the upper one- third of the vagina ,
usually at the apex or on the posteror wall
:Diagnosis

The diagnosis of carcinoma of the vagina is often

missed on first examination, particularly if the lesion is
small and situated in the lower two-thirds of the
vagina,where it may be covered by the blades of the
speculum. In patients with an abnormal Pap smear
and no gross abnormality , careful vaginal colposcopy
and the liberal use of Lugol s iodine to stain the vagina
are necessary. For definitive diagnosis of early vaginal
carcinoma, it may be necessary to resect the entire
vaginal vault and submit it for carful histologic
evaluation because the lesion may be partially buried
by closure of the vaginal at the time of hysterectomy
:Symptoms and Sign
painless vaginal bleeding and discharge -1
is usually postmenopausal but may be
postcoital
bladder pain and frequancy of micturition -2
 Staging

Stage I: The carcinoma is limited to the vaginal wall

Stage II: The carcinoma has involved the subvaginal
.tissue but has not extended to the pelvic wall
.Stage III : The carcinoma has extended to the pelvic wall
Stage IV :The carcinoma has extended beyond the true
pelvis or has involved the mucosa of the bladder or
rectum
IVA: Tumor invades bladder and/or rectal mucosa and/or
direct extension beyond the true pelvis
IVB: Spread to distant organs
Surgical staging for vaginal cancer has
been used less commonly than for
cervical cancer, but in selected
premenopausal patients , a
pretreatment laparotomy may allow
better definition of the extent of
disease, excision of any grossly
enlarged lymph nodes , and placement
of an ovary up into the paracolic gutter
beyond the radiation field
Patterns of spread
Direct extension -1
lymphatic dissemination -2
heamatogenous -3
dissemination
 Treatment
Therapy must be individualized and varies
depending on the stage of the disease and the
site of vaginal involvement , further limiting
individual experience. For most patients,
maintenance of functional vagina is an
important factor in the planning of therapy
Surgery-1
It has limited role in the management of
patients with vaginal cancer
a – in patient with stage I disease involving the
upper posterior vagina. If the uterus still in situ,
these patients require radical hysterectomy ,
partial vaginectomy ,and bilateral
lymphadenectomy
If the patient has hysterectomy , radical upper
. vaginectomy and pelvic lymphadenectomy
b- In young patient who require radiation
therapy. Pretreatment laparotomy in such patient
may allow ovarian transposition, surgical staging ,
. and resection of any enlarge lymph node
c- In patient with stage IVA disease ,particularly if
a rectovaginal or vesicovaginal fistula is present ,
pelvic exenteration is a suitable treatment
Radiation Therapy -2
It is the treatment of choice for all patients
. except those listed previously
If the lower 1/3 of the vagina is involved, the
groin nodes should be treated or dissected