Vaginal Anaplastic Lymphoma Kinase (ALK)-Positive Mesenchymal Tumor in a Young Patient: Expanding the Spectrum of Rare Genitourinary Neoplasms

TL;DR

A young woman was diagnosed with a rare vaginal tumor, highlighting the importance of accurate diagnosis and tailored treatment for such cases.

Contribution

This case expands the known spectrum of genitourinary neoplasms by identifying an ALK-positive mesenchymal tumor in the vaginal wall.

Findings

A 20-year-old patient had a spindle-cell ALK-positive mesenchymal tumor in the vaginal wall.

Complete surgical excision and multidisciplinary management were associated with no residual disease.

The case underscores the need for histopathology and immunohistochemistry in diagnosing rare vaginal tumors.

Abstract

Primary vaginal tumors are uncommon, and mesenchymal neoplasms in this location are even rarer, often resembling benign lesions such as fibroids or cysts. We present the case of a 20-year-old woman with a steadily enlarging anterior vaginal wall mass, initially suspected to be a fibroid based on clinical and radiological findings. Surgical excision revealed a spindle-cell proliferation with inflammatory infiltrates, and immunohistochemistry confirmed an anaplastic lymphoma kinase (ALK)-positive mesenchymal tumor. Postoperative imaging showed no residual disease, and a multidisciplinary team recommended surveillance given the complete excision and proximity of the lesion to the bladder trigone. This case emphasizes three clinical considerations: the importance of including rare mesenchymal tumors in the differential diagnosis of vaginal wall masses, the indispensable role of histopathology and immunohistochemistry in establishing a definitive diagnosis, and the need for tailored management strategies that balance oncologic control with preservation of function.

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