Vaginal Obliteration in a Woman With a History of Cutaneous T-Cell Lymphoma: The Results of Combined Chemotherapy-induced Gonadal Toxicity and Lymphoma Relapse

Abstract

Objective: Although ovarian failure commonly occurs following chemotherapy, the relation between menopause or related sexual activity in this failure is often overlooked. We report a case that emphasizes a clinically rare complication, the complete obliteration of the vagina. Case Report: A 42-year-old married woman with a history of Mayer-Rokitansky-Küster-Hauser syndrome, an established neovagina, and complete clinical remission of cutaneous T-cell lymphoma (stage T4) treated with bleomycin, cyclophosphamide, doxorubicin, vincristine and prednisolone had suffered from abdominal pain. Imaging studies (computed tomography) and laboratory evaluations indicating a suspicious pelvic abscess with leukocytosis (16,800/mm3) and elevated serum C-reactive protein (18.4 mg/L) levels. The patient underwent intensive medical treatment and surgical intervention, but died 2 months later. Pathology showed widespread lymphoma throughout the perineal area, including the neovagina, deep pelvic cavity and the entire abdominal cavity. Conclusion: Physicians should be greatly concerned about the frequency and severity of treatment-associated acute and long-term complications, such as gonadal toxicity. In this case, vaginal obliteration was an early sign of tumor recurrence, although menopause may have contributed to the vaginal obliteration.

Keywords

• chemotherapy
• cutaneous T-cell lymphoma
• Mayer-Rokitansky-Küster-Hauser syndrome
• ovarian failure