A rare case of primary vaginal carcinoma in prolapsed uterus

Primary carcinoma is rare in gynaecological neoplasia. Vaginal carcinoma in prolapse uterus is extremely rare. We hereby present a case of 55-year-old P3L3 postmenopausal woman with complete uterine prolapse with fungating growth of 6x8 cm with two decubitus ulcers of 1x1 cm. Marginal biopsy showed well-differentiated squamous cell carcinoma of vagina. Investigation was done showed no metastasis. Patient was diagnosed with stage 2 disease. Patient underwent 5 cycles of chemotherapy with 2 cycles of radiotherapy and is being followed up. The importance of biopsy of ulcer in cases of UV prolapse in order to exclude malignancy to avoid incomplete treatment has been illustrated through this case. The need of careful evaluation of vaginal erosions in pelvic organ prolapse has been highlighted. As there is lack of well-defined treatment protocols for vaginal cancer with concurrent prolapse, the case also underlines the importance of a multidisciplinary approach involving gynaecological oncology, urogynaecology, medical oncology, surgical oncology and radiation oncology.

Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion

Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.