A 49-year-old woman was admitted to the hospital with post-coital bleeding, right groin pain, fever, chills, and a palpable vaginal mass. The case report by medical student Todd R. Anderson from the Campbell University School of Osteopathic Medicine in Lillington, North Carolina, describes a rare case involving a combination of gynaecologic oncology and infectious disease featuring undocumented bacterial infection in the context of vulvar cancer.
Key Takeaways
- A case of metastatic squamous cell carcinoma complicated by a Fusobacterium necrophorum infection is presented.
- Multidisciplinary treatment, including antibiotic therapy, is critical for managing coexisting malignancies and infections.
- This case highlights the need for prompt intervention in complex oncologic infections.
The Patient and Her History
The patient presented to a rural hospital in Lillington with a painful right groin mass, fever, and chills for 3 days.
She reported that the pain was sharp and worsened with movement. The patient complained of post-coital vaginal bleeding and a palpable vaginal mass for the last 5 years.
In addition, the patient reported a rash on her torso and lower extremities for the past 9 months, which was being treated for scabies at the time of presentation.
The patient had a medical history of hypertension, type 2 diabetes mellitus, and hyperlipidaemia.
Her surgical history was normal, except for a total hysterectomy for benign causes. The patient reported that she had tested negative for sexually transmitted infections 5 years ago and had no previous history of such infections.
In addition, the patient had not undergone a Pap smear since her hysterectomy as Pap smears are usually discontinued after a total hysterectomy for benign causes.
The family, social, medication, drug, allergy, and travel histories were unremarkable.
Findings and Diagnosis
The patient’s vital signs were normal, except for an elevated temperature at admission. Physical examination confirmed the symptoms. Laboratory investigations revealed leucocytosis of 16,800/mm3. Urinalysis showed 3+ leukocyte esterase, +1 bacteria, and 2+ blood with 11-25 white blood cells. Blood cultures, chlamydia and gonorrhoea PCR, Treponema pallidum particle agglutination and rapid plasma regain tests were performed.
A CT scan of the abdomen and pelvis revealed an ovoid-shaped mass in the right groin measuring 3.5 × 4.9 cm with surrounding inflammation. No abnormalities were detected in the bladder, adnexa, or retroperitoneum.
Under anaesthesia, the patient underwent a vaginal examination. During the gynaecologic examination, an exophytic mass was found on the labia majora bilaterally. The left labia majora was entirely infiltrated by an exophytic, cauliflower-like lesion involving deeper tissues. The mass measured 3 × 3 cm in the superior and inferior directions and extended 6 cm into the vagina, sparing the vaginal cuff. Cystoscopy and rectal examination were performed to assess the extent of the disease, and both were normal.
The general surgery team performed lymphadenectomy. An incision was made on the right inguinal lymphadenopathy and dissected down to the enlarged lymph node. The lymph node was found to be necrotic and filled with purulent fluid. The pus was drained, and a sample was sent for laboratory analysis.
Tissue pathology of the lymph node showed metastatic squamous cell carcinoma with tumour necrosis. Anaerobic culture of the lymph node tissue sample revealed heavy growth of F necrophorum. An excisional biopsy of the vaginal mass revealed high-grade squamous cell carcinoma. The patient was referred for oncologic radiotherapy and gynaecologic oncology, and treatment was initiated according to clinical guidelines.
Discussion
“This case highlights the complexity of vulvar cancer complicated by metastatic lymph nodes infected with F necrophorum,” the authors wrote. Moreover, this case demonstrates the wide range of potential clinical manifestations associated with F necrophorum.
The authors further emphasised “the critical need for timely and appropriate management,” including anaerobic antibiotic coverage, to effectively address malignancy and associated infections.
This case highlights vulvar cancer with atypical presentations and reinforces the importance of a multidisciplinary approach to treating such complex cases.
This article was translated from Univadis Germany using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.