Carcinoma of the neovagina: case report and review of the literature.
BACKGROUND
Carcinoma of the vagina is a rare disease, and it is even more rare in the neovagina. Nevertheless, it has been well described. The aim of this report was to analyze the reported cases and to add observations concerning a risk profile for this rare occurrence of carcinoma.


METHODS
The 29-year-old patient's history included congenital absence of vagina as a result of Rokitansky-Kuster syndrome. In 1987, when the patient was 17 years old, a neovagina was constructed by dissection between the bladder and the rectum, according to the Warthon method, and the apex of the neovagina was covered with Dura-mater. In 1990 the patient underwent radiation treatment with brachytherapy three times in combination with surgical treatment, because of granulation tissue in the neovagina. In 1999 several specimens of the granulation tissue were removed and histological examination showed intermediate differentiated squamous cell carcinoma. Total exenteration with pelvic and lower paraaortic lymph node dissection was performed, and the patient received a continent neobladder (Mainz Pouch I), colostoma, and sigma neovagina. Two months later in January 2000 the patient showed local recurrence and after local excision the patient received radiotherapy. The follow-up to June 2001 showed no evidence of disease.


CONCLUSIONS
All patients with vaginoplasty should undergo regular 1-year follow-ups, including smear analysis because of the possibility of the development of carcinoma. Granulation tissue arising in a neovagina should be biopsied and no prosthesis should be used until lesions have healed completely. Patients who have undergone radiation of the neovagina carry an additional risk.
Steiner
Eric
E
Department of Gynecology and Obstetrics, University of Mainz, Mainz, FRG-55101, Germany. steiner@mail.uni-mainz.de
Woernle
Friedemann
F
Kuhn
Wather
W
Beckmann
Karin
K
Schmidt
Marcus
M
Pilch
Henryk
H
Knapstein
Paul Georg
PG
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D019738:Surgically-Created Structures / Q000473:pathology*; D014621:Vagina / Q000002:abnormalities / Q000601:surgery; D014625:Vaginal Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery