# Primary Invasive Squamous Cell Carcinoma of the Vagina Presenting Three Decades After Total Hysterectomy for Benign Endometriosis: A Case Report

## TL;DR

A woman developed vaginal cancer 30 years after a hysterectomy for benign endometriosis, highlighting the need for ongoing gynecological monitoring.

## Contribution

This case report presents a rare instance of primary invasive squamous cell carcinoma of the vagina occurring decades after a total hysterectomy for benign disease.

## Key findings

- A 57-year-old woman presented with a lesion at the vaginal fornix, later diagnosed as HPV-associated invasive squamous cell carcinoma.
- Histopathology confirmed moderately differentiated invasive squamous cell carcinoma with lymphovascular invasion and negative surgical margins.
- The case emphasizes the importance of continued gynecological surveillance in patients who have undergone hysterectomy for benign conditions.

## Abstract

A 57-year-old woman (G2P2) with a history of total hysterectomy for endometriosis 30 years earlier, presented for a routine gynecological examination without complaints. Speculum examination revealed an erythematous, raised plaque at the right lateral fornix, 2-3 cm from the vaginal cuff. Pathology from the lesion demonstrated high-grade squamous intraepithelial lesion (HSIL) with HPV-16 positivity. Colposcopic biopsies from the 2, 7, 9, and 11 o’clock positions confirmed HSIL, with half of the samples suspicious for invasion. The patient underwent a partial vaginectomy, and histopathology revealed a moderately differentiated, HPV-associated invasive squamous cell carcinoma (SCC) with lymphovascular invasion. Margins were negative. This case demonstrates a unique case of primary vaginal cancer decades after hysterectomy for benign disease, underscoring the importance of continued gynecological surveillance in hysterectomy patients with previously benign findings.