Mixed tumor of the vagina with atypical features: a case report including clinical management

OBJECTIVES: To present a rare case of mixed vaginal tumor with atypical features and to discuss clinical management in the context of uncertainty regarding biological behavior. METHODS: We present the clinical course of a 50-year-old woman with a history of endometriosis and a recurrent vaginal mass who was diagnosed with a mixed tumor with atypical features and uncertain behavior. Following wide local excision, the multidisciplinary team reached a consensus to proceed with close surveillance without initiating adjuvant therapy. RESULTS: The patient underwent excision of a 1 × 2 cm pedunculated vaginal mass with 1-2 cm margins. Pathology confirmed a mixed tumor with atypical features, 13 mitoses per 10 high-power fields, and irregular borders. Postoperatively, the patient had episodes of severe vaginal pain and swelling, including foul-smelling discharge and dysuria at day 9, and recurrent pain at 1 and 2 months. Imaging demonstrated only mild postsurgical changes without abscess, and symptoms resolved with antibiotics and supportive care. Given the absence of high-risk pathological features and no evidence supporting adjuvant therapy, the multidisciplinary team recommended surveillance. Three months after resection, the patient remained without evidence of disease. CONCLUSIONS: This case underscores the need for greater awareness and research to guide management and recurrence prevention for rare vaginal tumors. Complete resection is critical, and the potential benefits of adjuvant therapy must be weighed against risks such as sexual dysfunction, psychological impact, and treatment-related morbidity.