case_images: PMC6220397_01
case_images: (a) MRI imaging showed a tumor at the anterior wall of the residual vagina (arrow). (b) Microscopic examination of biopsy for the vaginal tumor showed adenocarcinoma (hematoxylin-eosin stain, original magnification: x400).
case_images: CRIU2018-3069294.001.jpg
case_images: PMC6220397_01_CRIU2018-3069294.001.jpg
case_images: fig1
case_images: The patient developed continuous pain and bleeding from the residual vagina in 2010, and a tumor was found in the residual vagina; magnetic resonance imaging (MRI) showed it to be located on the anterior wall (Figure 1(a)). A biopsy of the tumor revealed a pathological diagnosis of adenocarcinoma (Figure 1(b)).
case_images: Microscopic finding of the vaginal tumor. (a) There were round to spindle-shaped cells having scanty cytoplasm and high mitotic activity (arrow). The pathological diagnosis was small cell carcinoma (hematoxylin-eosin stain, original magnification: x400). (b) On immunohistochemistry, the tumor was found to be positive for CD56, chromogranin A and synaptophysin (original magnifications: x400). Positivity for these makers suggested that the tumor was small cell carcinoma.
case_images: CRIU2018-3069294.002.jpg
case_images: PMC6220397_01_CRIU2018-3069294.002.jpg
case_images: fig2
case_images: Based on a preoperative diagnosis of a primary adenocarcinoma occurring on the residual vagina, tumor resection was performed (Figure 2(a)). On pathological examination, adenocarcinoma and SCC were detected (Figure 2(b)); on immunohistochemistry, sections of the tumor were positive for the SCC markers CD56, chromogranin A, and synaptophysin and were negative for the urothelial carcinoma markers GATA-3, p63, uroplakin, thrombomodulin, and 34betaE12.
case_images: Microscopic finding of the initial TURBT. (a) We examined the TURBT specimen again and found that there were SCC and foci of adenocaricinoma in the superficial layer of the specimen (hematoxylin-eosin stain, original magnification: x400). This result indicated that the vaginal tumor was a recurrence of SCC and adenocarcinoma of the urinary bladder. (b) High-grade UC in the TURBT specimen (hematoxylin-eosin stain, original magnification: x100).
case_images: CRIU2018-3069294.003.jpg
case_images: PMC6220397_01_CRIU2018-3069294.003.jpg
case_images: fig3
case_images: We then reexamined the original TURBT specimen and confirmed the presence of SCC (Figure 3).