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Case Report Open Access

Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report

  • Authors:
    • Tingting Wang
    • Xin Li
    • Liping Chen
    • Jing Zhang
    • Lina Peng
    • Haitao Yang
  • View Affiliations / Copyright

    Affiliations: Department of Gynecology, Women and Children's Hospital Affiliated to Ningbo University, Ningbo, Zhejiang 315000, P.R. China, Department of Imaging, Women and Children's Hospital Affiliated to Ningbo University, Ningbo, Zhejiang 315000, P.R. China, Department of Histopathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang 315000, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 295
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    Published online on: May 14, 2026
       https://doi.org/10.3892/ol.2026.15650
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Abstract

Primary vaginal cancer is a rare malignant tumor; its pathogenesis remains unclear and only a limited number of cases have been documented in the literature. The present report outlines a rare case of primary vaginal endometrioid adenocarcinoma that occurred in a patient 3 years after a total hysterectomy for uterine adenomyosis. Pathogenesis, clinical features, diagnosis, treatment and prognosis are discussed to improve clinical recognition and management of this rare condition. A 49‑year‑old female patient who had undergone a total hysterectomy for uterine adenomyosis 3 years earlier presented with postcoital vaginal bleeding. Gynecological examination identified a mass in the vaginal stump. A biopsy revealed low‑grade vaginal adenocarcinoma. The patient underwent an extensive laparoscopic parametric resection, partial upper vaginectomy, pelvic lymph node dissection and bilateral oophorectomy. The postoperative pathology determined a diagnosis of primary vaginal endometrioid adenocarcinoma. Concurrent chemoradiotherapy was initiated 6 weeks after surgery. At the last follow‑up (15 months postoperatively), the patient was in good general condition with no evidence of recurrence. The present case indicates that long‑term surveillance of the vaginal stump is valuable for patients who have undergone total hysterectomy for benign uterine diseases, as it allows early detection of vaginal stump lesions. In particular, for patients with a history of other malignant tumors, specific attention should be paid to the genetic susceptibility of the underlying tumor.
View Figures

Figure 1

Clinical timeline summarizing the
disease course. Schematic illustrating the entire process from the
initial diagnosis, progression of the disease and discovery of
vaginal stump lesions, through to surgery, radiotherapy and
chemotherapy. D&C, dilation and curettage; LNG-IUS,
levonorgestrel-releasing intrauterine system.

Figure 2

Histopathological features of a
cervical polyp. (A) H&E-stained section showing characteristic
morphology. In the upper left quadrant (arrow) fibrovascular stroma
shows dense chronic inflammatory cell infiltration. The mid-upper
field contains cystically dilated glands (arrow). The lower right
area (arrow) shows the surface epithelium with focal squamous
metaplasia overlying columnar epithelium (magnification, ×10; scale
bar, 200 µm). (B) H&E-stained section of an endometrial
curettage specimen. Pathological analysis revealed a small amount
of endometrium with proliferative changes (arrows) (magnification,
×20; scale bar, 100 µm).

Figure 3

Histopathological findings in a
hysterectomy specimen for adenomyosis. (A) H&E staining of the
uterine corpus demonstrating typical features of adenomyosis.
Ectopic endometrial glands and stroma (arrow) are present within
the hypertrophic myometrium, extending beyond the normal
endometrial-myometrial junction. The ectopic glands appear
irregular and dilated, accompanied by surrounding stromal
proliferation (magnification, ×10; scale bar, 200 µm). (B) H&E
staining of normal cervical tissue from the same specimen. The
ectocervix is covered by intact, orderly stratified squamous
epithelium (arrow), with underlying fibrous stroma containing
scattered stromal cells (arrow) (magnification, ×10; scale bar, 200
µm).

Figure 4

Histopathological features of poorly
differentiated adenocarcinoma of the vagina. H&E-stained
sections showing an infiltrative adenocarcinoma characterized by
markedly atypical glands and pleomorphic cells with hyperchromatic
nuclei. Lymphocytic infiltration is evident in the adjacent stroma
of (A) the left vaginal wall (arrow) (magnification, ×10; scale
bar, 200 µm) and (B) the right vaginal wall (arrow) (magnification,
×10; scale bar, 200 µm).

Figure 5

Computed tomography of the urinary
tract demonstrating postoperative changes in the pelvis, including
a left pelvic sidewall cyst, consistent with a lymphocele and
prominence of the vaginal cuff (highlighted by the red circle).

Figure 6

Post-contrast MRI demonstrating a
punctate soft-tissue nodule along the left posterolateral aspect of
the vaginal cuff. (A) The nodule exhibits mildly high signal
intensity on axial T2-weighted imaging (red circle). (B) Marked
enhancement on sagittal contrast-enhanced T1-weighted imaging is
shown (red arrow). The lesion shows ill-defined margins with the
vaginal wall, with slight irregularity of the outer vaginal
contour. These imaging features are highly suggestive of a vaginal
cuff malignancy.

Figure 7

Histopathological evidence of
aggressive local invasion. (A) Perineural invasion (arrow).
H&E-stained section of the parametrial and upper vaginal
resection specimen showing a nerve bundle encircled and invaded by
nests of adenocarcinoma cells (magnification, ×10; scale bar, 200
µm). (B) Lymphovascular invasion (arrow). H&E-stained section
from the same specimen demonstrating tumor cell emboli within a
vascular channel, demonstrating lymphovascular invasion
(magnification, ×10; scale bar, 200 µm).

Figure 8

Findings from the 15-month
postoperative surveillance pelvic ultrasound appear unremarkable,
with no identifiable mass or suspicious soft tissue lesion.
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Copy and paste a formatted citation
Spandidos Publications style
Wang T, Li X, Chen L, Zhang J, Peng L and Yang H: Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report. Oncol Lett 32: 295, 2026.
APA
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., & Yang, H. (2026). Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report. Oncology Letters, 32, 295. https://doi.org/10.3892/ol.2026.15650
MLA
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., Yang, H."Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report". Oncology Letters 32.1 (2026): 295.
Chicago
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., Yang, H."Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report". Oncology Letters 32, no. 1 (2026): 295. https://doi.org/10.3892/ol.2026.15650
Copy and paste a formatted citation
x
Spandidos Publications style
Wang T, Li X, Chen L, Zhang J, Peng L and Yang H: Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report. Oncol Lett 32: 295, 2026.
APA
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., & Yang, H. (2026). Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report. Oncology Letters, 32, 295. https://doi.org/10.3892/ol.2026.15650
MLA
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., Yang, H."Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report". Oncology Letters 32.1 (2026): 295.
Chicago
Wang, T., Li, X., Chen, L., Zhang, J., Peng, L., Yang, H."Primary endometrioid adenocarcinoma of the vagina after total hysterectomy for adenomyosis: A case report". Oncology Letters 32, no. 1 (2026): 295. https://doi.org/10.3892/ol.2026.15650
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