DIAGNOSIS: Well-differentiated squamous cell carcinoma of the vagina, T1 N0.
55/F , First seen in the Colposcopy Clinic with abnormal cytology from the vaginal vault.
The vaginal vault was noted to have a whitened epithelium, particularly towards the apical region.
Bx: VIN 3 from the 12 o’clock position and from the vaginal apex. Also at the 3 o’clock position but additionally, several foci of small, well-differentiated invasive squamous cell carcinoma were seen all with a depth of less than 1 mm and a focal lymphovascular space invasion. Tumor was noted to extend to the base of the biopsy.
P/H: Testing for HPV done in 2005 which was positive. Was monitored with regular colposcopy.
TAH/BSo 2008 for dysplasia noted in the cervix. No invasive ca on path.
NO H/O STD (sexually transmitted diseases).
Another major problem: Significant Interstitial cystitis of unknown etiology. She was at the point where she was considering a cystectomy but a trial of MacroBID antibiotic has been very helpful in reducing her symptoms.
Now nocturia x2 but prior to MacroBID it was 8 times.
Local Exam: No inguinal femoral LNpathy. Inspection of the external genitalia unremarkable. On speculum exam no visible discreet lesions. On palpation there are no abnormal areas of thickening to suggest obvious disease.
IMPRESSION: 55/F old woman with biopsy proven squamous cell carcinoma of the vagina that is well differentiated with known prior HPV infection and prior dysplasia in the cervix with underlying interstitial cystitis of unknown etiology.
I saw this lady for treatment? Given the focal lympho vascular invasion should I worry out lymph nodes (para vaginal atleast)?