The management of the patient with abnormal vaginal cytology following hysterectomy

Abstract

Summary. Thirty‐two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21·8%) had had hysterectomy for benign conditions whilst 25 (78·1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty‐five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34·3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5‐fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28·1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.

Management of vaginal intraepithelial neoplasia: A series of 132 cases with long-term follow-up

“…Surgical excision of the vaginal vault can be repeated and in our series this led to the diagnosis of invasive carcinomas in a further two instances. Occult invasion has also been reported by other authors, including Ireland and Monaghan (9) who found invasive carcinoma in 28% (9/32) of surgically excised vaginal vault specimens and Hoffman et al (12) . who found occult invasion in 64% (9/14) cases.…”

“…Postmenopausal atrophy should be corrected by the use of intravaginal estrogen cream prior to colposcopy. In the post‐hysterectomy patient vaginal vault angles can present a problem as they can be funneled precluding complete colposcopic assessment (9) . Singer (10) has described the use of hooks for the assessment of these recesses.…”

“…The technique of upper vaginectomy or vault excision has been described by several authors (9,10,14) using different techniques. The utmost care should be made to avoid “buttonholing,” traumatizing, or thermally damaging the specimen.…”

Vaginal epithelial abnormalities in patients with CIN: clinical and pathological features and management

“…1988) this benefit must be weighed against possible longer term disadvantages, including distortion and narrowing of the vagina, a potential for inducing neo‐epithelial abnormalities and making subsequent interpretation of vaginal cytology very difficult. Topical agents such as 5‐fluorouracil give unreliable and unpredictable results (Ireland & Monaghan 1988).…”

Risk factors for recurrence of vaginal intraepithelial neoplasia in the vaginal vault after laser vaporization

“….5% of patients with VAIN [2,6,7]. Moreover, hysterectomy for CIN is also a known risk factor the subsequent development of VAIN, with historical recurrence rates ranging from 0.9% to 6.8% [8][9][10].…”