English

Abstract

Malignant tumors of vagina are rare accounting for 1 to 4 % of all genital malignancies. Rarest of rare is spindle cell sarcoma of vagina having a very poor prognosis. 47yrs old, regularly menstruating woman, completed family, presented with hard painful ulcerated swelling near the vaginal introitus and lower vaginal wall of 4 months duration. On examination, 2x4cms sized ulcerated growth with excavated base, covered with necrotic material, present in the left antero-lateral lower end of vagina, inner to hymenal ring which was tender, hard, indurated, infiltrating, fixed to base and did not bleed to touch. Another nodule of size 1x1cm tender, hard, fixed and necrotic was present below the external urethral meatus. HPE revealed Amelanotic malignant melanoma of vagina. Immunohistochemistry revealed Spindle cell sarcoma of vagina. Tumor board recommended neo-adjuvant chemotherapy and radiotherapy (CT + EBRT). Of the recommended 50Gy, she completed 46Gy in 23days and 1 course of chemotherapy (VAC). On review after 9 months, the lesion disappeared clinically and she was advised to complete the treatment. Inspite of radio and chemotherapy secondaries to lungs and brain could not be prevented and the patient expired 20 months after the final