Primary Invasive Squamous Cell Carcinoma of the Vagina Presenting Three Decades After Total Hysterectomy for Benign Endometriosis: A Case Report

A 57-year-old woman (G2P2) with a history of total hysterectomy for endometriosis 30 years earlier, presented for a routine gynecological examination without complaints. Speculum examination revealed an erythematous, raised plaque at the right lateral fornix, 2-3 cm from the vaginal cuff. Pathology from the lesion demonstrated high-grade squamous intraepithelial lesion (HSIL) with HPV-16 positivity. Colposcopic biopsies from the 2, 7, 9, and 11 o'clock positions confirmed HSIL, with half of the samples suspicious for invasion. The patient underwent a partial vaginectomy, and histopathology revealed a moderately differentiated, HPV-associated invasive squamous cell carcinoma (SCC) with lymphovascular invasion. Margins were negative. This case demonstrates a unique case of primary vaginal cancer decades after hysterectomy for benign disease, underscoring the importance of continued gynecological surveillance in hysterectomy patients with previously benign findings.