# 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.

## Key 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.