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Vaginal Cancer
Jason Ryan, MD, MPH
Vaginal Malignancies
• Vaginal carcinoma
• Clear cell carcinoma
• Embryonal rhabdomyosarcoma (infants)

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Vaginal Carcinoma
• Very rare
• Usually squamous cell carcinoma
• Almost always involves HPV
• Same risk factors as cervical cancer
• Rarely a primary tumor of vagina
• Most commonly: extension of cervical carcinoma
Lymphatic Drainage
• Upper vagina
• From Mullerian duct
• Iliac nodes
• Lower vagina
• From urogenital sinus AfraTafreeh.com
• Inguinal nodes

Wikipedia/Public Domain
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Clear Cell Carcinoma

• Rare malignancy of cervix or vagina
• Associated with maternal diethylstilbestrol (DES)
• Nonsteroidal estrogen
• Used to prevent miscarriage, premature birth
• Removed from US market 1971
• Female babies: Reproductive tract abnormalities

Pixabay/Public Domain
Diethylstilbestrol
• Abnormal uterus, cervix
• Vaginal adenosis
• Vaginal clear cell adenocarcinoma
• High rate of infertility
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Vaginal Adenosis
• Upper vagina: Mullerian duct
• Lower vagina: Urogenital sinus
• Adenosis
• Mullerian tissue in outer cervix/vagina
• Columnar epithelium in vagina
• Lack of normal squamous epithelium
• Associated with in utero DES exposure
• May lead to clear cell carcinoma
Sarcoma botryoides
Embryonal Rhabdomyosarcoma

• Rare vaginal tumor of young children

• May also develop in boys
• “Paratesticular tumors”
• Scrotal or inguinal enlargement
• Derives from embryonal rhabdomyoblasts
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• Immature muscle cells
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Sarcoma botryoides
Embryonal Rhabdomyosarcoma

• Occurs in children < 5 years old

• Clear, grape-like mass growing from vagina
• Botryoid = appearance of bunch of grape
• May invade peritoneum → obstruct bladder
• Treatment: surgery and chemotherapy
Desmin
• Muscle filament
• Part of Z-disks in sarcomeres
• Marker of rhabdomyosarcoma
• 99% of rhabdomyosarcomas positive for desmin
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Myosin Actin

Z disk