Unveiling the hidden malignancy: primary vaginal squamous cell carcinoma in longstanding third-degree uterovaginal prolapse-a rare case report

Abstract

Primary vaginal squamous cell carcinoma (SCC) is a rare malignancy, representing only 1–2% of all gynecologic cancers. Its occurrence in association with longstanding third-degree uterovaginal prolapse (UVP) is extremely uncommon, occurring in <1 % of cases. This overlap presents unique diagnostic challenges, as ulcerative lesions in prolapse may mimic benign decubitus ulcers, leading to delayed detection and treatment. A 70-year-old multiparous postmenopausal woman presented with a 25-years history of third-degree UVP, accompanied by foul-smelling vaginal discharge and difficulty in defecation for 6 months. Clinical examination revealed a 10 × 8 × 2 cm ulcerative, exophytic lesion involving the entire left lateral part of the vaginal wall with a small ulcer free area below the introitus. The cervix appeared hypertrophied with keratinization. The prolapsed portion was irreducible even under anesthesia. Histopathologic examination of a biopsy specimen confirmed moderately differentiated Vaginal Squamous Cell Carcinoma. Pelvic MRI demonstrated bilateral iliac lymphadenopathy without invasion of adjacent organs. In view of the patient’s advanced age and frailty, she was deemed unsuitable for surgical intervention. Definitive external beam radiotherapy was initiated and she continues to be monitored under oncologic care. This case highlights the importance of maintaining a high index of suspicion for malignancy in elderly patients with longstanding pelvic organ prolapse and atypical vaginal ulcerations. Early biopsy and imaging are critical for timely diagnosis. Clinicians should be vigilant for malignancy masquerading as decubitus ulcers in UVP, as early detection can significantly alter management strategies and improve outcomes.