Diagnosis and management of grade IV pelvic organ prolapse with stage II vaginal carcinoma: a case report

Abstract

Aim: This case report aimed to illustrate the diagnosis and management of a rare case of grade IV pelvic organ prolapse (POP) and stage II vaginal carcinoma.

Background: Pelvic organ prolapse is common in older women, with its prevalence peaking at 5% in women aged 60-69. Long-term prolapse may increase the risk of malignant transformation. Vaginal carcinoma, accounting for 1-3% of gynecological cancers, is rare, and its occurrence alongside pelvic organ prolapse is exceptionally uncommon.

Case Report: A 77-year-old woman presented with discomfort due to a vaginal mass for 10 years. She was diagnosed with grade IV uterine prolapse, grade IV cystocele, and stage II vaginal carcinoma. The patient underwent transvaginal hysterectomy, anterior colporrhaphy, colpoperineorrhaphy, and bilateral inguinal lymphadenectomy. Histopathological examination revealed keratinizing squamous cell carcinoma (Grade 2, pT1 pN0 pMx).

Conclusions: Clinicians should consider vaginal carcinoma in patients with pelvic organ prolapse presenting with vaginal masses or bleeding. The Pelvic Organ Prolapse Quantification (POP-Q) system is recommended for prolapse assessment, while vaginal carcinoma staging follows the FIGO system. Surgical intervention is the primary treatment for advanced prolapse with symptoms. Early detection of vaginal carcinoma in prolapse cases can improve management and outcomes.

Clinical Significance: Vaginal carcinoma associated with pelvic organ prolapse is rare, and no standardized guidelines exist for the diagnosis and management of this complex condition.