Vaginal obliteration in a woman with a history of cutaneous T-cell lymphoma: the results of combined chemotherapy-induced gonadal toxicity and lymphoma relapse.
OBJECTIVE
Although ovarian failure commonly occurs following chemotherapy, the relation between menopause or related sexual activity in this failure is often overlooked. We report a case that emphasizes a clinically rare complication, the complete obliteration of the vagina.


METHODS
A 42-year-old married woman with a history of Mayer-Rokitansky-Küster-Hauser syndrome, an established neovagina, and complete clinical remission of cutaneous T-cell lymphoma (stage T4) treated with bleomycin, cyclophosphamide, doxorubicin, vincristine and prednisolone had suffered from abdominal pain. Imaging studies (computed tomography) and laboratory evaluations indicating a suspicious pelvic abscess with leukocytosis (16,800/mm(3)) and elevated serum C-reactive protein (18.4 mg/L) levels. The patient underwent intensive medical treatment and surgical intervention, but died 2 months later. Pathology showed widespread lymphoma throughout the perineal area, including the neovagina, deep pelvic cavity and the entire abdominal cavity.


CONCLUSIONS
Physicians should be greatly concerned about the frequency and severity of treatment-associated acute and long-term complications, such as gonadal toxicity. In this case, vaginal obliteration was an early sign of tumor recurrence, although menopause may have contributed to the vaginal obliteration.
Pan
Chuan-Chien
CC
Department of Obstetrics and Gynecology, National Yang-Ming University Hospital, Ilan, Taiwan.
Lee
Wen-Ling
WL
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D019738:Surgically-Created Structures; D014621:Vagina / Q000002:abnormalities / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000473:pathology*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D001761:Bleomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone