Rapid progression of primary vaginal squamous cell carcinoma in a young HIV-infected woman

Background. The association of human immunodeficiency virus (HIV) infection with rapid progression of cervical and anal squamous cell carcinoma has be en clearly established by several studies. Human papilloma virus (HPV) infe ction of the anogenital tract is believed to be the causative agent of cerv ical, anal, vaginal, and vulvar squamous cell carcinoma. While a myriad of reports exist in the literature pertaining to the rapid progression of cerv ical and anal carcinoma in HIV-infected patients, no association of HIV inf ection and vaginal carcinoma has been reported. We present an unusual case of a young woman infected with HIV who was diagnosed with advanced vaginal carcinoma and succumbed to her disease shortly thereafter despite aggressiv e treatment. Case. A 40-year-old woman with a 2-year history of HIV infection presented with Stage IVA squamous cell carcinoma of the vagina and a large vesicovagi nal fistula from the tumor eroding through the posterior bladder wall. Comp uted tomography (CT) of the abdomen and pelvis revealed a large tumor repla cing the vagina with mild hydronephrosis and diffuse pelvic and inguinal ly mphadenopathy. She underwent urinary diversion with a transverse colon cond uit followed by pelvic radiation with weekly cisplatin chemosensitization. A repeat CT scan of the abdomen and pelvis upon completion of her treatment revealed progression of disease with multiple liver metastases and gastroh epatic ligament adenopathy. She subsequently died of advanced metastatic va ginal carcinoma 2 months after completion of treatment. Conclusion. Due to the rarity of primary vaginal carcinoma, the clinical be havior of this neoplasm in the HIV-infected patient is poorly understood. O ur case indicates that, although vaginal carcinoma is a disease of the elde rly, young women infected with HIV and HPV are predisposed not only to deve lop cervical or anal carcinoma but also may be at increased risk for vagina l carcinoma with more aggressive and less responsive disease, Furthermore, although vaginal carcinoma is usually a slow-growing neoplasm, this case il lustrates the aggressive behavior of such a tumor when associated with HIV infection. (C) 2000 Academic Press.