Glassy cell carcinoma is considered as the most poorly differentiated form of adenosquamous carcinoma. The most frequent location is in the cervix [1][2][3].

It occurs in various other sites of genital tract: Fallopian tubes, body of endometria and vagina [4][5][6][7].

The management of this tumor is based on surgery, radiotherapy, and chemotherapy [2][3]. To our knowledge, this case is the second reported case of glassy cell carcinoma of the vagina.

A 24-year-old female was admitted to our department for atypical genital bleeding for about six months. She had no history of prenatal diethylstilbestrol exposure or sexual intercourse.

Gynecological examinations revealed a circumscribed, ulcerated tumor originating in the vaginal wall. This tumor was occupied the upper and middle third of vaginal wall. The uterine cervix and parameters were apparently intact. Inguinal lymph nodes were not evident.

Microscopic examination of the biopsied specimen of the tumor revealed sheets of large cells with abundant inflammatory infiltration consisting predominantly of eosinophils and lymphocytes characterized by large nuclei with prominent nucleoli. Cells showed a moderate amount of granular or clear cytoplasm. We observed a high mitotic rate and many abnormal mitoses and distinct cell membrane stained well by PAS stain. Finally, the presence of necrosis area was noted. The pathological diagnosis of glassy cell carcinoma was made (Figure 1) (Figure 2) (Figure 3).

Abdominal and pelvic computed tomography (CT) scan showed an important tissue thickening affecting all vaginal walls with a multitude of centimetric pelvic lymphadenopathy affecting the common, external iliac nodes and left obturator nodes. No distant metastasis was detected.

Magnetic resonance imaging (MRI) scan of abdomen and pelvis: The wall thickening affecting the vagina was objectified with an important infiltration of the adjacent pelvic paravaginal tissues and presence of centimetric pelvic and lomboaortic lymphadenopathy.

The patient was diagnosed with stage III according to 'International Federation of Obstetrics and Gynecology' (FIGO) system 1998.

After the diagnosis was made, she was treated by neoadjuvant chemotherapy for down staging by six courses of triweekly chemotherapy with paclitaxel and carboplatin.

The response rate was 30% (partial response) under physical examination and magnetic resonance imaging.

Following chemotherapy, she underwent an open laparoscopy. We proceed to a lomboaortic lymphadenectomy and ovarian transposition.

Lomboaortic lymphadenectomy showed all 23 lymph nodes were negative on pathological examination.

At last, a conventional concomitant radio-chemotherapy (RT-CT) was performed at a dose of 50 gray, at 2 gray per session, five days week, for 5 weeks, with a boost of 10 gray on the iliac lymph node area.

The patient is still alive, without evidence of recurrence, 6 months following the radiation therapy.

Adenosquamous carcinoma of the vagina has rarely been reported in literature. Indeed only 6 cases were reported to our knowledge [8][9][10] .

The glassy cell carcinoma is considered as the most poorly differentiated form of adenosquamous carcinoma [2] [3]. It may originate from multipotential stem or reserve cells that undergo early squamous differentiation [11].

The majority of glassy cell carcinoma reported cases affecting the gynecological tract involved the cervix. However vaginal involvement, although rare, is possible as demonstrated by our case.

Symptoms and imaging are those of any other vaginal tumors.

Thus, the diagnosis is pathological. Histologically, the glassy cell carcinoma is composed by cells arranged in nests and cords separated by fibro vascular septa. The stromal infiltration is predominantly composed of eosinophil cells and plasma cells with an admixture of lymphocytes, giving a very characteristic appearance.

The cytoplasm's cells are eosinophilic, sometimes amphophilic, with a ground glass appearance and distinct cell membrane stained well by PAS stain. The nuclear membrane is dense. The majority of the nuclei are large, vesicular and hyper chromatic, round to oval, containing exceptionally large and prominent nucleoli [2][3].

Mitotic activity is important with cellular pleomorphism and numerous abnormal mitoses. Focal squamous or glandular differentiation may be seen but not in the reported case. Small foci of necrosis are frequently present as shown in the related case.

Treatment depends on the stage of the vaginal tumor according to FIGO's classification. It is based on multimodal therapy: surgery combined with chemotherapy and radiotherapy.

Due to its rapid growth, resistance to conventional treatment modalities, and aggressiveness, the glassy cells carcinoma are characterized by a high frequency of distant metastases explaining them poor prognosis; this finding is valid whatever the primary site of the tumor [12].

The poor prognosis of glassy cell carcinoma makes it useful to individualize it, to better plan its management. The present case illustrates the potential for glassy cell carcinoma to arise throughout the female genital tract but also through the lymphatic node and shows the need for multidisciplinary care.

Dr Raoudha Doghri from anatomical pathology department of institute salah azaiz, Tunis,Tunisia.

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