Vaginal squamous cell carcinoma with sarcomatoid spindle cell features

A vaginal squamous cell carcinoma with prominent sarcomatoid spindle cell features found in a 25-year-old female is presented. The exclusively spindle-shaped growth pattern of the neoplastic cells in the initial biopsy led to the diagnostic impression of a sarcoma. This in turn has resulted in an attempt at completely resecting the tumor. The 5.2 x 3.5-cm resected lesion, however, blended peripherally with a poorly differentiated squamous cell carcinoma. Moreover, the sarcomatoid component reacted with vimentin and cytokeratin, and tonofilaments and desmosomes were seen by electron microscopy. This apparently unique case indicates the need for obtaining representative tissue samples for providing an appropriate diagnosis prior to definitive therapy for vaginal squamous cell carcinoma. The primary treatment for large stage I squamous cell lesions of the vagina is radiotherapy, whereas an equally large sarcoma is best treated by wide local excision alone.