Vaginal obliteration after total body irradiation and chemotherapy as treatment for acute myeloid leukemia.
Although radiotherapy is an integral part in the management of certain types of hematological malignancies, its effect on the reproductive system has been well documented. We report a rare complication where a patient had complete vaginal obliteration after receiving a dose of total body irradiation (1575 cGy) as part of her treatment for acute myeloid leukemia. A 37-year-old married woman, G3P2, underwent high-dose cyclophosphamide accompanied by high dose (1575 cGy) total body irradiation (TBI) as part of her treatment for acute myeloid leukemia (AML: m1) when she was 35 years of age. After TBI, the patient developed ovarian failure and amenorrhea, which was confirmed by hormonal evaluation. Nevertheless, she did not receive any hormonal replacement therapy and stopped her sexual life for two years. Fortunately, no recurrence of AML was noted. The patient visited our clinic due to difficulty in performing coitus. Physical examination showed a 2-cm short and blinded vaginal pouch. She initially received hormonal replacement therapy followed by surgical correction via vaginoplasty and two months of dilatory replacement and frequent coitus with satisfactory result. To our limited knowledge, vaginal obliteration as a complication of condition regimen has never been reported before. In the present case report, it is unclear whether spontaneous vaginal obliteration resulted from chemotherapy, total body irradiation, or another unknown cause such as a concomitant leukemic infiltration of the vaginal wall, severe bacterial and fungal infection before treatment, or from any combination of the above. However, due to this case presentation, we suggest that such patients must receive hormonal replacement therapy and be encouraged to have a normal sexual life to avoid this possible problem.
Lee
W L
WL
Division of Metabolism and Endocrinology, Department of Medicine, Veterans General Hospital, Taipei, 201, Section 2, Shih-Pai Road, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yuan
C C
CC
Chao
H T
HT
Chen
P M
PM
Lin
H D
HD
Wang
P H
PH
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003075:Coitus; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017254:Leukemic Infiltration; D012746:Sexual Abstinence; D014621:Vagina / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D000970:Antineoplastic Agents; D003520:Cyclophosphamide