Gynecologic Oncology Reports 36 (2021) 100764 Available online 8 April 2021 2352-5789/© 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Case report Menstural function preservation treatment of a primary vaginal clear cell carcinoma with ovarian transposition and vaginal brachytherapy Dimitrios-Efthymios Vlachos a, * , Athanasios Protopapas a , Georgios Vlachos a , Kyrillos Sarris b , Maria Sotiropoulou c , Maria Terzi d , Dimitris Loutradis a a 1st Department of Obstetrics and Gynecology, University of Athens, Greece b Department of Radiotherapy, General Hospital “Alexandra”, Athens, Greece c Department of Pathology, General Hospital “Alexandra”, Athens, Greece d Department of Pathology, ‘Hygeia’ Diagnostic and Therapeutic Centre of Athens - Hygeia, Greece A R T I C L E INFO Keywords Clear cell carcinoma Vaginal cancer Brachytherapy Preservation of menstrual function ABSTRACT Early stage vaginal carcinomas are typically treated with radical surgical procedures or radiation therapy. Both modalities impair the reproductive ability of the patients. We hereby report a case of menstrual function pres- ervation in a 24-year-old patient with an early-stage primary vaginal clear cell carcinoma. We treated the patient with intravaginal brachytherapy after appropriate laparoscopic surgical staging and separate transposition of the ovaries and tubes. The patient is now 6 years without any evidence of disease. She reports minor. complaints during sexual intercourse, while her menstruation and hormonic profle are normal. 1. Introduction Primary clear cell adenocarcinoma of the vagina (vCCA) is a rare tumor that accounts for 1% of all vaginal carcinomas (Hanselaar et al., 1997). vCCA is associated with diethylstilbestrol (DES) exposure, congenital anomalies of urogenital tract, and metaplasia of endometri- otic nodules (Uehara et al., 2010). The main symptoms that lead patients to seek medical care are abnormal vaginal bleeding, discharge and/or dyspareunia. About 10–25% patients are asymptomatic, and the tumor is detected during regular checkup. Vaginal examination reveals a protruding nodule at the anterior upper third of the vaginal wall, and the diagnosis is confrmed via punch biopsy. The disease incidence has a bimodal distribution with peaks in the third and seventh decades of life. (Hanselaar et al., 1997) This indicates that vCCA may be detected in young patients before childbearing. For such patients, conservative treatments, including radical colpo- trachelectomy, wide local excision or brachytherapy, have been suc- cessfully implemented. 2. Case report A 24-year-old Greek female student with postcoital vaginal bleeding and no other complaints presented to our department. She was of normal physical status (ACOG PS = 0, BMI = 24, Karnofsky = 100%). Her medical history was free of any operative procedures or medical prob- lems, and she did not report any chronic pharmacological treatment. She had regular Pap smears since the age of 21 years and had never been pregnant. Her family history was unremarkable, and her mother re- ported that she had never consumed DES. Pelvic examination revealed a 2 cm wide hemorrhagic nodule. which protruded in the upper left third of the vagina. The inner genitalia and parametria showed no signs of infltration, and cervix, vulva and the rest of vagina were also unremarkable. A colposcopic examination of the cervix and vagina revealed only the nodule on the vaginal wall and a punch biopsy was performed (Fig. 1). Histopathologic examination revealed a poorly differentiated adenocarcinoma with morphological and immunohistochemical characteristics compatible with a clear cell carcinoma. The tumor exhibited positive immunoreactivity for CK7, CEA, focal positive for CD15, and negative immunoreactivity for Vimentin, CD10, CK5/6, Calretinin, WT1, RCC, and ER (Fig. 2) The patient was further evaluated with abdominal magnetic * Corresponding author at: 80 Leoforos Vasilissis Sofas Str., 11526 Athens, Greece. E-mail addresses: vlachos.dg@gmail.com (D.-E. Vlachos), prototha@otenet.gr (A. Protopapas), dimitri@otenet.gr (D. Loutradis). Contents lists available at ScienceDirect Gynecologic Oncology Reports journal homepage: www.elsevier.com/locate/gynor https://doi.org/10.1016/j.gore.2021.100764 Received 20 January 2021; Received in revised form 22 March 2021; Accepted 27 March 2021