Case Report: Primary HPV-Negative Vaginal Cancer
Primary vaginal cancer is a rare disease, accounting for only 1–3% of all gynecologic malignancies worldwide. It most commonly occurs in older women or in those with a positive history of HPV infection. As explained, in some regions with higher HPV prevalence, infection rates are higher among younger women, and persistent HPV infection is associated with an increased risk of developing malignant disease. For this reason, the occurrence of primary vaginal cancer in a young woman with a history of normal Pap smear results represents an extremely rare situation. However, a new case is particularly notable for its rarity, as it involves a primary, HPV-negative vaginal carcinoma diagnosed in an otherwise healthy 32-year-old woman.
The case was described by Erin Carter, Teri Nguyen-Guo, Paulina Guta, Vikram Soni, and Jennifer McEachron in the report titled “Rare case of primary HPV negative vaginal cancer presenting in a young woman with normal cervix.”
A healthy 32-year-old Caucasian woman
The patient, a healthy 32-year-old Caucasian woman, presented to her gynecologist with a mass on the anterior vaginal wall that caused discomfort and dyspareunia, that is, pain during sexual intercourse. Pap smears were performed annually and were consistently normal, and her family history was negative for gynecologic malignancies. The cytological examination of the approximately 1 cm mass suggested a ruptured inclusion cyst. Despite the treatment, the symptoms worsened. Subsequent examination revealed a firm mass measuring 2 × 0.5 cm that was tender to palpation. “The apical vagina and cervix were noted to be grossly normal. Biopsy was performed at this time, and the result was consistent with invasive keratinizing squamous cell carcinoma. Immunohistochemical staining was not performed. Additionally, cervical biopsies were obtained and resulted as benign,” the authors noted.
Seven months after completion of therapy
The patient began treatment with concurrent chemoradiation, which she tolerated well. Seven months after completion of therapy, there was no evidence of disease, and follow-up continued with regular examinations every three months. “Our patient was treated successfully according to the National Comprehensive Cancer Network (NCCN) guidelines for primary vaginal cancer, including chemoradiation and brachytherapy,” they wrote in the report.
Due to persistent dyspareunia, approximately one and a half years later, a decision was made to perform a partial vaginectomy with vaginal reconstruction. The most recent findings showed no evidence of disease. This case highlights the importance of timely biopsy of suspicious vaginal lesions, even in the absence of clear risk factors for malignancy.
Image: HPV, The Fred & Pamela Buffett Cancer Center
