Vaginal cancer classification

Vaginal cancer may be classified according to histopathology into squamous cell carcinoma, adenocarcinoma, vaginal sarcoma and melanoma.

Types of vaginal cancer, in order of prevalence, include:

• Vaginal squamous cell carcinoma:

• Squamous cell carcinoma accounts for the majority of vaginal cancers.
• The mean age at diagnosis of squamous cell carcinomas is approximately 60 years.^[1]
• These tumors may be nodular, ulcerative, indurated, endophytic, or exophytic.
• Vaginal cancer is also associated with the human papillomavirus (HPV).
• Vaginal epithelium is more stable than cervical epithelium, which undergoes constant metaplasia, and is less susceptible to oncogenic viruses^[2].
• Verrucous carcinoma is a less common variant of vaginal squamous cell carcinoma that is well-differentiated and has low malignant potential^[3].
• It usually presents as a large, warty, fungating mass that is locally aggressive but rarely metastasizes.

• Vaginal adenocarcinoma:

• Adenocarcinomas represent as primary vaginal cancers in women younger than 20 years old^[1].
• Adenocarcinomas arise in areas of vaginal adenosis, Wolffian rest elements, periurethral glands.
• Clear cell variants are the best known type of adenocarcinoma.
• Clear cell carcinoma presents in young women who have been exposed in utero to diethylstilbestrol (DES)^[4].
• Clear cell carcinomas of the vagina present as polypoid masses,on the anterior wall of the vagina.
• DES exposure can result in both cervical and vaginal clear cell adenocarcinomas^[5].
• The incidence of invasive or in situ squamous cell cancer of the cervix is increased in women exposed to DES in utero^[6].
• It is recommended that women exposed to DES in utero have their first gynecologic examination at menarche.

• Vaginal sarcoma:

• Rhabdomyosarcoma in pediatric population, eg. sarcoma botryoides, Leiomyosarcomas, endometrial stromal sarcomas, malignant mixed müllerian tumors.
• Rhabdomyosarcomas are the major types of primary vaginal sarcomas^[7].
• The most common of these is the embryonal rhabdomyosarcoma (sarcoma botryoides).
• Sarcoma botryoides is highly malignant tumor that occurs in the vagina during infancy and early childhood.
• This sarcoma generally presents as soft nodules that fill and sometimes protrude from the vagina, resembling a bunch of grapes (botryoides comes from the Greek word botrys, which means “grapes”)

Melanoma:

• Melanomas arising on the vaginal mucosa are rare’
• It mostly originate from mucosal melanocytes in areas of melanosis or from atypical melanocytic hyperplasia^[8].
• The presenting symptom is most commonly vaginal bleeding.
• They appear as a blue-black or black-brown mass, plaque, or ulceration, most frequently on the distal one-third of the anterior vaginal wall.
• They are often nonpigmented.
• Primary malignant melanomas of the urogenital mucous membranes may have aggressive behavior with a high rate of local failure and metastases^[9].