Vaginal sarcoma is a malignant tumor that develops from the connective tissue structures of the vaginal tube. The course of this disease is characterized by rapid growth, decay and metastasis; clinically manifested by serous-bloody discharge, dysuric disorders, pain. Diagnosis is based on the data of gynecological examination, colposcopy, biopsy. Treatment includes a surgical stage followed by radiation and polychemotherapy. The prognosis for vaginal sarcoma is unfavorable.
In gynecology, vaginal sarcoma is a relatively rare type of tumor; it is usually found in girls up to 3-5 years old and menopausal women (50-60 years old). The type of tumors in children and adults is different: in girls, embryonic vaginal rhabdomyosarcoma is diagnosed, in women – leiomyosarcoma, fibrosarcoma, angiosarcoma, melanosarcoma. According to the histological structure, spindle-cell, round-cell and polymorphocellular sarcomas of the vagina differ.
The course of pediatric vaginal sarcoma is extremely malignant. The tumor has a polypoid or cluster-shaped shape, rapidly increases in size, accumulates, disintegrates with the formation of necrotic ulcers, infiltrates the urethra, bladder, cervix, parametrium, rectum. In adult women, vaginal sarcoma looks outwardly like a limited node or diffuse flat infiltrate, early metastasizes to pelvic and inguinal lymph nodes and distant organs (more often lungs and spine).
Given the rapid growth rate, vaginal sarcoma begins to manifest itself clinically already with a sufficiently deep invasion, ulceration and decay. A typical sign is the appearance of serous and pus-like secretions with an admixture of blood, hematuria. There is moderate contact bleeding of the tumor. Often these symptoms are mistaken for manifestations of vaginitis, which prevents the timely diagnosis of vaginal sarcoma.
With the growth of sarcoma, there are sensations of a foreign body in the vagina, abdominal pain with irradiation to the lower back and lower extremities, an increase in the inguinal glands. The germination of the tumor of the organs of the urinary and intestinal tract is accompanied by dysuric phenomena and defecation disorders – pain, urinary incontinence and feces. With the prevalence of the tumor process, a decrease in appetite, weight loss, nausea, vomiting increases.
During gynecological examination, a towering lumpy node or infiltrate of a dense or soft consistency, bleeding when touched, is found on the anterior, less often the posterior wall of the vagina. In girls, polypoid growths usually protrude into the genital cleft through the hymen in the form of a “bunch of grapes”. Sometimes, to examine a girl with vaginal sarcoma, it is necessary to resort to surgical defloration. Clarifying information is obtained during colposcopy (vaginoscopy). For the purpose of morphological verification of the formation, a biopsy and histological examination of tumor tissues are performed.
Disease in the process of diagnosis is differentiated from papilloma, tuberculous and syphilitic ulcers, vaginal cancer, endometriosis, chorionepithelioma metastases, injury to the vaginal wall. To exclude tumor invasion of adjacent organs, consultations of a urologist, proctologist, pulmonologist are indicated; cystoscopy, intravenous urography, rectoromanoscopy, lung radiography, pelvic ultrasound.
Oncogynecologists use surgical, radiation, and chemotherapeutic methods in the treatment of vaginal sarcoma. The most radical intervention for vaginal sarcoma is a hysterectomy (removal of the uterus) with the removal of the vagina and lymph nodes. In some cases, this volume is supplemented by vulvectomy, removal of the bladder (cystectomy) and urethra with ureteral transplantation into the colon.
Subsequently, repeated courses of remote radiotherapy and intracavitary brachytherapy, polychemotherapy (prospidium chloride, fluorouracil, bleomycin, cisplatin, cyclophosphamide, doxorubicin, vincristine) are performed.
The development of sarcoma in some cases is preceded by vaginal polyps, initially benign in structure, which dictates the need for their removal immediately after diagnosis. Due to the long asymptomatic period, in the vast majority of clinical cases, the diagnosis of vaginal sarcoma is established with a significant delay.
Late diagnosis, as well as extreme aggressiveness of the course of vaginal sarcoma determine an unfavorable outcome. According to clinical observations, the cure is achieved in less than 5% of patients.