Diagnosis and treatment of postoperative high-grade vaginal lesions in a case of cervical malignant tumor

Diagnosis and treatment of postoperative high-grade vaginal lesions in a case of cervical malignant tumor | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnosis and treatment of postoperative high-grade vaginal lesions in a case of cervical malignant tumor Pengcheng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6877258/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract A case of cervical malignant tumor complicated with vaginal lesions 3 years after operation is reported. The patient was HPV16 positive before operation, biopsy showed cervical squamous cell carcinoma stage IB2, after corresponding surgical treatment and adjuvant chemotherapy, HPV multiple positive infections were reexamined 3 years after operation, biopsy showed vaginal HSIL and vulvar LSIL. After fractional laser surgery combined with petrin treatment, the result was finally HPV negative and the condition was cured. Figures Figure 1 Figure 2 Figure 3 1 Case report A 51-year-old female patient was admitted to the hospital due to "vaginal lesions found 1 month after 3 years of cervical malignant tumor surgery".LMP: April 5, 2021, regular menstruation, 1-0-0-1, normal labor, no history of co-bedroom hemorrhage and abnormal hemorrhage, no history of special diseases and surgery, denied history of drug allergy.In 2021, he went to the local hospital due to "vulvar pain and vulvar herpes for 1 week", and the examination showed HPV16 positive. TCT suggested ASCUS, colposcopy suggested SCJ type 3, and the proposed diagnosis was cervical HSIL. Biopsy pathology suggested HSIL involved glands (cervical 4 points), local early infiltration, and HSIL involved glands (cervical 6 and 9 points). Local squamous cell hyperplasia on the left side of vagina.2021-5-18 He went to the Cancer Hospital Affiliated to Fudan University for diagnostic cervical conization and cervical scraping. Postoperative pathology revealed invasive carcinoma of the cervix, some squamous cell carcinoma, depth of invasion 8mm in conization tissue, vascular invasion (-), invasive carcinoma of the incisal margin. ECC breaks up cancerous tissue, mucus and cervical mucosa. Advise hospitalization for further surgical treatment.On May 27, 2021, the patient was admitted to Fudan University Cancer Hospital and underwent radical hysterectomy, retroperitoneal lymphadenectomy, bilateral salpingo-oophorectomy, and para-aortic lymph node dissection. Postoperative pathology revealed: ① An exophytic + endophytic tumor measuring 4.5 × 2.5 × 1.5 cm; ② Histological type: Non-keratinizing squamous cell carcinoma; ③ Depth of invasion: Full-thickness involvement of the cervical fibromuscular wall with adjacent organ invasion, making pathological assessment difficult; ④ Vascular tumor emboli: Extensive (+), perineural invasion (-). Left parametrial tissue: Vascular tumor emboli. Right parametrial tissue: Vascular tumor emboli. Vaginal margin (-); ⑤ Uterine corpus: Endometrium exhibited secretory-phase morphology, with two intramural leiomyomas measuring 0.5 cm and 1 cm in diameter. Bilateral adnexa: No evidence of metastatic carcinoma;⑥Lymph node status: (6/23) (metastatic/total), with carcinoma metastasis identified. Left pelvic (1/6), right pelvic (1/8), left common iliac (2/4), right common iliac (0/1), para-aortic (0/1), right parametrial (2/3).Postoperative treatment included 28 sessions of pelvic radiotherapy, 4 cycles of DDP chemotherapy, and 4 cycles of paclitaxel combined with carboplatin chemotherapy.In the 2022 follow-up examination, no significant abnormalities were detected in the complete blood count, liver and kidney function tests, tumor marker SCC levels, or pelvic CT scan.In March 2023, the patient visited Fudan University Shanghai Cancer Center. Tumor markers were within normal range. HPV testing showed positive for types 31, 56, 53, 43, and 54. TCT results indicated ASCUS. Colposcopic evaluation revealed post-radiotherapy changes, and no biopsy was performed. The patient was advised to undergo regular follow-up.Visited Fudan University Shanghai Cancer Center on April 9, 2024. HPV testing showed positive for types 18, 53, 6, 43, 54, and 81. TCT result indicated ASC-H. Colposcopy revealed post-radiotherapy vaginal changes with tissue rigidity and pale mucosa, suggestive of vaginal HSIL. Biopsy pathology confirmed HSIL at the vaginal stump. Pelvic MRI demonstrated postoperative uterine changes with normal SCC levels. Referral to the Cervical Disease Department of Obstetrics and Gynecology Hospital of Fudan University was recommended for further treatment.Visited the Cervical Department of Obstetrics and Gynecology Hospital affiliated to Fudan University on June 5, 2024. Physical examination showed stable vital signs, with no abnormalities detected on cardiopulmonary auscultation. The abdomen was soft and non-tender without rebound tenderness. Gynecological examination revealed a married-type vulva, patent vagina with slight shortening, well-healed vaginal stump, rigid and congested mucosal tissue that bled easily upon contact. Ancillary tests: Fudan University Shanghai Cancer Center HPV test: positive for types 18, 53, 6, 43, 54, and 81. TCT: ASC-H. Colposcopy-guided biopsy pathology: HSIL at the vaginal stump. Pelvic MRI: post-hysterectomy changes, normal SCC. Estrogen cream was applied vaginally for 14 days for preparation, followed by colposcopic evaluation. Findings included vaginal mucosal bleeding and rigidity. Preliminary diagnosis: vaginal HSIL and vulvar LSIL. Vulvar biopsy was performed(Fig. 1 ). Pelvic contrast-enhanced MRI indicated post-hysterectomy changes with bilateral inguinal lymphadenopathy (largest node approximately 1 cm), recommended for follow-up. Currently, no evidence of vaginal invasion was observed. After thorough discussion with the patient and family, considering the poor response to CO2 laser therapy post-pelvic radiotherapy and the presence of multiple vaginal lesions, fractional laser therapy was proposed, supplemented by topical Patelin treatment postoperatively. The risks of recurrence and potential malignant transformation were clearly communicated.2024-06-05 On July 16, 2024 and November 8, 2024, laser surgery for vaginal lesions was performed. On November 8, 2024 and January 3, 2025, laser surgery for vaginal + vulvar lesions was performed༈Fig. 2 ༉. After surgery, Paitalin was given vaginally. Sexual life was strictly prohibited. Vaginal ultrasound was followed up regularly. Blood routine, liver and kidney function and SCC showed no obvious abnormality.2025-03-14 Reexamination in Fudan University Recurrent Obstetrics and Gynecology Hospital showed HPV negative, TCT: NILM, pelvic CT suggested changes after hysterectomy. Estrogen vaginal preparation 14 days, colposcopy: vaginal mucosa pink, elasticity than before significantly improved, vinegar white staining vaginal mucosa significantly less bleeding, suspected diagnosis: inflammatory changes, biopsy pathology: (vaginal apex tissue) a small amount of free squamous epithelial tissue༈Fig. 3 ༉. Post-operative education was given, and it was suggested to reexamine it six months later. 2 Colposcopy images and laser treatment images Figure 1, 2 and 3 are belongs here. 3 Discussion 3.1 Vaginal intraepithelial neoplasia (VaIN), also known as vaginal squamous intraepithelial lesion (vaginal SIL), refers to atypical proliferative diseases occurring in different degrees in the vaginal epithelium and closely related to human papillomavirus (HPV) infection [ 1 ] . HPV persistent infection is the most important factor for VaIN occurrence and development. Studies have found that [ 2 ] HPV is an independent risk factor for VaIN occurrence and prognosis. It has been reported in the literature that the detection rate of HPV in VaIN1 and VaIN2-3 is about 90%, and the detection rate in vaginal cancer is about 60%. The most common type is still HPV16, followed by 52, 58 and 53 [ 3 ] . The peak age of VaIN was 35–58 years old. The older the age, the higher the risk and grade of VaIN. The onset age was later than that of CIN [ 4 ] . Vaginal lesions were multicentric and multifocal, often involving the upper 1/3 of the vagina, often combined with CIN or CC. Therefore, patients with hysterectomy due to CIN or CC have a higher incidence of VaIN and are even more likely to develop high-grade VaIN or even vaginal cancer [ 5 ] . Due to the relatively low incidence of VaIN and vaginal cancer, most patients are asymptomatic and are detected only when referred to colposcopy due to abnormal cytology or HPV screening results, coupled with the fact that many colposcopists are inexperienced and do not realize the importance of vaginal lesions, do not perform colposcopy to assess vaginal conditions before hysterectomy, or do not regularly follow up vaginal lesions after hysterectomy, there are many missed patients. 3.2 Currently, the screening for VaIN still relies on cytology, HPV testing, and colposcopy, with biopsy of suspicious lesions under colposcopy remaining the gold standard for diagnosis [ 6 – 7 ] . Abnormal cytology/HPV screening results are the primary indications for colposcopy, particularly in the following scenarios, where vaginal lesions should be suspected: 1. Abnormal cervical screening results with no suspicious lesions detected on cervical evaluation—a comprehensive assessment of the vaginal wall should be performed, focusing on the upper third and fornix. 2. Persistent HPV positivity or abnormal cytology after treatment for HPV-related diseases (e.g., cervical HSIL treated with cervical conization/LEEP or hysterectomy). 3. Follow-up after VaIN treatment. 4. Visible vaginal wall abnormalities or residual stump growths during gynecological examination. 5. Unexplained abnormal discharge, fluid leakage, bleeding, or postcoital bleeding. Colposcopy for VaIN also presents several challenges [ 8 ] : 1. The vaginal wall has numerous folds and high elasticity, making many lesions prone to concealment and difficult to fully expose under colposcopy (e.g., vaginal laxity, prolapse, or scattered lesions). In post-hysterectomy patients, lesions may hide in the lateral vaginal angles. 2. Inexperienced colposcopists may overlook fornix lesions, inadequately control biopsy depth, fail to obtain valid specimens, or cause excessive depth-related complications, including damage to adjacent organs [ 9 ] . 3. Reduced estrogen levels in postmenopausal women may impair observation, with insufficient awareness of this effect [ 10 ] . 4. In post-radiotherapy patients, vaginal shortening, loss of elasticity, and tissue rigidity increase the difficulty of lesion detection and biopsy risks. 3.3 The current treatment modalities for VaIN primarily include: pharmacological therapy (estrogen, imiquimod cream, traditional Chinese medicine preparations such as paiteling, baofukang suppository, etc.), physical therapy (CO₂ laser, electrocautery, photodynamic therapy, cryotherapy, etc.), surgical treatment (total vaginectomy, partial vaginectomy, local vaginal resection, etc.), and radiotherapy. Regardless of the treatment approach, VaIN carries the risk of lesion recurrence and progression, particularly in patients who have undergone hysterectomy due to CIN or CC, necessitating long-term and rigorous follow-up.Reportedly, the risk of vaginal LSIL progressing to vaginal cancer is relatively low, while the risk of vaginal HSIL progressing to invasive cancer is approximately 3.2–5.8%, with an average progression time of 54–61 months [ 11 – 12 ] . Therefore, combined cytology and HPV testing is essential, and abnormal screening results should prompt timely referral for colposcopy.The selection of VaIN treatment should be individualized, taking into account factors such as the patient's age, physical condition, medical history, lesion location, and the desire to preserve sexual function. Long-term management and close follow-up are required. 3.4 In this case, the patient underwent total hysterectomy due to cervical malignancy, followed by adjuvant chemoradiotherapy. Two years postoperatively, HPV testing revealed multiple infections, and colposcopy was performed without biopsy. The following year, persistent multiple HPV infections were detected, and colposcopy-guided biopsy confirmed vaginal HSIL. A retrospective analysis of potential high-risk factors for postoperative vaginal HSIL in this patient identified the following: ①Preoperative reassessment of vaginal involvement was not performed; ②Partial vaginectomy was not conducted during surgery; ③Postoperative HPV/cytological follow-up was not promptly intensified; ④Initial postoperative colposcopy did not include biopsy (due to atypical lesions post-pelvic radiotherapy, random biopsy could have been considered for exclusion); ⑤ Postoperative colposcopy should have been performed by an experienced physician. Based on the colposcopic findings and pathological results, invasive carcinoma was ruled out, and surgical or radiation therapy was not considered. Laser therapy was deemed feasible; however, due to pelvic radiotherapy, multifocal and scattered lesions, the vaginal epithelium exhibited poor responsiveness to laser, posing challenges such as suboptimal treatment efficacy, high recurrence rates, and potential risk of disease progression to invasive carcinoma. Fractionated laser therapy combined with traditional Chinese medicine (Pateling) for antiviral treatment was proposed. After obtaining informed consent from the patient and family, multiple sessions of vaginal and vulvar laser therapy were performed by a senior physician at our hospital, followed by regular intravaginal medication. After nine months, both cytology and HPV testing normalized. Colposcopic evaluation suggested inflammatory changes, and biopsy pathology revealed minimal free squamous epithelium, ultimately achieving complete negative results. Currently, there is no consensus on the treatment of VaIN. The therapeutic approaches mentioned in the article are all feasible and should be tailored based on individual patient conditions. Considering the relatively high risk of vaginal HSIL progressing to invasive cancer in this patient, particularly in association with CC, active intervention is recommended [ 13 – 14 ] . Laser therapy utilizes the high thermal effect generated by a CO₂ laser to vaporize tissue and promote squamous epithelial regeneration, thereby achieving lesion removal. It is suitable for clearly exposed lesions. The procedure does not require anesthesia, is convenient to perform, offers precise targeting, and allows for controlled depth with strong repeatability. It is associated with fewer complications, minimal intraoperative and postoperative bleeding, reduced postoperative discharge, and minimal local burning reactions, while preserving vaginal anatomy and function to the greatest extent. Given the patient's condition and physical factors, CO₂ laser therapy is a relatively safe, low-side-effect, and highly effective treatment option. The depth of laser treatment is directly correlated with its efficacy. Studies report that the average thickness of vaginal lesions at all levels is generally < 1 mm [ 15 ] . Therefore, a treatment depth of 1–1.5 mm (including the thermal necrosis zone) and a treatment margin of 3–5 mm beyond the lesion are recommended. Excessive depth may lead to reduced vaginal elasticity, contracture, bleeding, delayed healing, or even vaginal fistula formation. Standardized laser therapy requires comprehensive colposcopic evaluation before treatment, particularly at the bilateral vaginal apex after total hysterectomy. If the apex cannot be fully exposed or is deeply hidden with potential lesions that cannot be ruled out, vaginoscopic evaluation, biopsy, or even treatment may be necessary [ 16 ] . This patient, being in an estrogen-deficient state, required vaginal estrogen preparation for at least two weeks (after excluding estrogen contraindications) prior to both colposcopy and laser therapy. The bilateral vaginal apex was clearly visible under colposcopy, eliminating the need for further vaginoscopy. It is important to note that post-hysterectomy patients with a thin vaginal apex (< 3 mm), especially after radiotherapy, are at risk of apex rupture and fistula formation. Preoperative vaginal ultrasound assessment of apex thickness is essential, and the importance of experienced physicians performing biopsies and surgeries should be reiterated. Due to the patient's poor physical tolerance and extensive lesion involvement, four laser sessions were administered for vaginal lesions and two for vulvar lesions, supplemented with local antiviral and mucosal repair therapy during the treatment period. 3.5 Currently, there are no specific drugs for pharmacological treatment. The drugs mentioned in the literature are those that have shown relatively favorable outcomes based on empirical use. The Chinese herbal preparation Paiteling discussed in this article is a pure herbal liquid formulation developed by the Chinese Academy of Sciences for topical application, wet compress, or diluted irrigation of the lower genital tract. It is primarily composed of heat-clearing and detoxifying herbs such as Sophora flavescens and Hedyotis diffusa, supplemented by corrosion-removing and insecticidal herbs like Brucea javanica and Cnidium monnieri, and is refined through modern scientific extraction processes [ 17 ] . Experimental studies have confirmed that Paiteling may inhibit the proliferation and migration of Ect1/E6E7 cells by suppressing the Wnt/β-catenin pathway and reduce the incidence of cervical cancer by downregulating the expression of E6/E7 oncogenes [ 18 ] . Mouse experiments have demonstrated that Paiteling can stimulate immune responses, enhance immune reactivity in mice, and thereby reduce the viral load of HPV in infected tissues[19]. Paiteling is a liquid formulation. For treating cervical and vaginal lesions, 1 mL of the undiluted drug should be drawn using a specialized pipette and injected into the vagina while maintaining a head-low, hip-high position for at least half an hour to ensure adequate absorption. The dosage and treatment cycle should be adjusted based on the patient's condition. In this case, the patient was administered the drug for four consecutive days per week (before bedtime) with a three-day rest period to allow for drug absorption and vaginal mucosal recovery. After multiple rounds of laser therapy combined with pharmacological treatment, this patient achieved an unexpected outcome of complete lesion resolution and HPV clearance, suggesting that the treatment of vaginal intraepithelial neoplasia (VaIN) should not be limited to a single therapeutic approach. Combination therapy may yield relatively better results. However, this report represents a single case, and the patient's good compliance and adherence to medical advice were contributing factors. 4 Conclusion The understanding, diagnosis, and treatment of vaginal HSIL still require heightened attention, further exploration, and rigorous management. As the detection rate of vaginal lesions gradually increases, the challenges faced by colposcopists also escalate. Regression of vaginal HSIL is rare, with high risks of recurrence and progression, necessitating effective doctor-patient communication, strict long-term follow-up, and management. For this patient with initial regression, a follow-up interval of 6 months is recommended, including TCT and HPV testing. If abnormalities are detected, referral for colposcopy is advised; if results are normal, repeat TCT and HPV testing after 12 months is suggested. After two consecutive negative screenings, the frequency may be reduced to annual combined screening. Any positive result or abnormal symptoms during this period should prompt referral for colposcopy, along with continued imaging (CT/MRI) and tumor marker evaluations. In summary, this article reports a case of successful reversal of vaginal HSIL, analyzing its etiology, diagnostic pitfalls, examination, treatment, and follow-up. The findings provide valuable clinical experience for diagnosis and treatment, offering a reference for the management of similar cases, which holds certain clinical significance. Declarations Statement of funds This article is not funded and is for personal work experience sharing. Ethical Statement This study adhered to the relevant international and national ethical guidelines. Ethical approvals were obtained for human research, and participants provided informed consent. In human research, participants have provided written informed consent and the option to withdraw at any point. Data collection and processing adhered to privacy protection principles, with all personally identifiable information either deleted or encrypted. We commit to presenting the findings of this study with honesty, objectivity, and responsibility, ensuring that they are not altered or distorted in any manner that may mislead readers or undermine the study's integrity. Release form Dear reviewers, I am writing this article to express my personal experience in the diagnosis and treatment of this disease and hope to get your support and approval. I hereby submit it in the form of a consent form. The following is my position and reasons on this issue:Cervical cancer is the second largest female death tumor in the world. Many cervical cancer patients neglect the importance of postoperative reexamination after surgery and ignore the possibility of postoperative vaginal lesions. After this report, the patient found vaginal HSIL, through active physical therapy and drug treatment, the final outcome of the disease was cured, preventing further aggravation and recurrence of the disease.Therefore, I firmly believe that patients with cervical cancer after surgery still need regular and close follow-up, alert to vaginal lesions and vulvar lesions subsequent occurrence, early detection and early treatment, thus improving life treatment. Confirmation I collected case information, picture editing, article writing and postoperative follow-up by Wang Pengcheng. I am the only contributor to the article. There is no conflict of interest. Disclosure statement The authors reported no potential conflicts of interest. Data availability statement The case information involved throughout the article has been comprehensively incorporated into this published article. Statement All personal information and case contents involved in this article, including medical history, diagnosis and treatment process, diagnosis and treatment pictures, pathological results, etc., were written after informed consent of patients, and patients agreed to publish the report. References Rountis A,Pergialiotis V,Tsetsa P,et al. Management options for vaginal intraepithelial neoplasia[J]. Int J Clin Pract,2020, 74(11):e13598. Jiahui Wei,Yumei Wu.Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Archives of Gynecology and Obstetrics[J] .2024, 310:1–10. Ao M,Zheng D,Wang J,,et al. A retrospective study of cytology and HPV genotypes results of 3229 vaginal intraepithelial neo plasia patients[J].J Med Virol,,2022,94（2）:737-744. Boonlikit S,Noinual N. Vaginal intraepithelial neoplasia:A ret rospective analysis of clinical features and colpohistology[J].J Obstet Gynaecol Res,2010,36（1）:94-100 . Tidy J. The risk of vaginal cancer is associated with a history of cervical neoplasia[J].BJOG,2020,127(4):455. Rountis A,Pergialiotis V,Tsetsa P,et al.Management options for vagi nal intraepithelial neoplasia[J].Int J Clin Pract,2020,74(11): e13598. Brown BH,Tidy JA. The diagnostic accuracy of colposcopy A review of research methodology and impact on the outcomes of quality assurance［J］. Eur J Obstet Gynecol Reprod Biol, 2019,240：182-186. Kesic V.Carcopino X,Preti M,et al. The European Society of Gynaecological Oncology（ESGO）,the International Society for the Study of Vulvovaginal Disease(ISSVD),the European Col lege for the Study of Vulval Disease(ECSVD),and the Euro pean Federation for Colposcopy(EF)consensus statement on the management of vaginal intraepithelial neoplasia[J].Int J Gy necol Cancer,2023,33（4）:446-461. Wei Lihui, Zhao Yun. Modern Colposcopy [M]. 3rd ed. Beijing: Peking University Medical Press, 2016: 5. Chinese Expert Consensus on the Diagnosis and Treatment of Postmenopausal Cervical Intraepithelial Lesions (2022 Edition) [J]. Oncology Progress, 2022, 20(14): 1405-1411. Sopracordevole F,Clemente N,Di Giuseppe J,et al. Clinical Characteristics and Long-Term Follow-up of Patients Treated for High-Grade Vaginal Intraepithelial Neoplasia：Results From a 20-Year Survey in Italy[J].J Low Genit Tract Dis, 2020,24(4):381-386. KimMK,Lee IH,Lee KH. Clinical outcomes and risk of recur rence among patients with vaginal intraepithelial neoplasia:A comprehensive analysis of 576 cases[J].J Gynecol Oncol, 2018,29(1):e6. Chinese Association of Minimally Invasive and Non-invasive Medicine, Gynecologic Oncology Committee; Chinese Association for the Promotion of Health Science and Technology, Female Reproductive Tract Diseases Diagnosis and Treatment Branch; Chinese Association for the Promotion of Health Science and Technology, Oncofertility Branch. Expert Consensus on the Diagnosis and Treatment of Vaginal Intraepithelial Neoplasia (2020) [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(8): 722-728. Hodeib M,Cohen JG,Mehta S,et al. Recurrence and risk of progression to lower genital tract malignancy in women with high grade VAIN[J].Gynecol Oncol,2016,141(3):507-510. Cui C,Xiao Y,Lin E,et al. Precise Measurement of the Thick ness of Vaginal Intraepithelial Neoplasia[J］. J Low Genit Tract Dis,2022,,26(3):245-249. Chen Limei, Zhang Hongwei, Wang Qing, et al. Application of vaginoscopy in the diagnosis and treatment of occult high-grade squamous intraepithelial lesions at vaginal fornix angles[J]. Chinese Journal of Obstetrics and Gynecology, 2021, 56(8): 569-575. Liu Lianhui, Qin Wenmin, Zhang Yingxue, et al. Meta-analysis of the efficacy of Paiteling in the treatment of high-risk human papillomavirus (HR-HPV) infection. Chinese Traditional and Herbal Drugs. 2021, 52(22):6928-6938. Liu Y H, Zhao Z J, Zhang X X, et al. Effects of Paiteling on Proliferation, Migration and PI3K/Akt Signaling Pathway in HeLa Cells. Chinese Journal of Experimental Traditional Medical Formulae, 2020, 26(17): 56-63. Xu R. Effects of five drugs on immune responses in a nude mouse model of HPV infection. Tianjin: Tianjin Medical University, 2019. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6877258","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":491709593,"identity":"858b493b-fe68-4082-b178-cb9f9b714818","order_by":0,"name":"Pengcheng Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACfmbmw49/VPyTk2dvIFKLZDtbmjHDmQPGhj0HiNRi0M9jIM3YdiCx4UYCsVqYeQyMC9vuJDbOfLzxBkONTTRBLebMbAWPZ5x7ZtwunVZswXAsLbeBkBbLZuYNBjxlzLKNs3PMJBgbDhPWYnCYwUCCh42ZseHmGaK1sBhI87QdVmy4wUOkFslmtjTDGWfSgIEM9EsCMX7h5z98+MGHChtgVB7eeONDjQ1hLSiOlEggRTlEC6k6RsEoGAWjYGQAAFhhQb5yyfhfAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Pengcheng","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-06-12 06:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6877258/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6877258/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87894091,"identity":"caddfee1-e0d9-4b05-84b0-d907f250214c","added_by":"auto","created_at":"2025-07-30 07:13:46","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":757752,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative colposcopy image of laser(2024-6-5)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6877258/v1/334b71b7ea3190d7fdce7bb9.jpeg"},{"id":87893266,"identity":"6f12430f-a0cc-46e8-ae80-bcd3ac3953bf","added_by":"auto","created_at":"2025-07-30 07:05:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":316314,"visible":true,"origin":"","legend":"\u003cp\u003eVaginal and laser vulvar treatments\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6877258/v1/5e42a39a88490a108090be67.png"},{"id":87893265,"identity":"9693264b-c010-4558-bb23-81856fe7fabf","added_by":"auto","created_at":"2025-07-30 07:05:45","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":725952,"visible":true,"origin":"","legend":"\u003cp\u003eVaginal endoscope images after multiple laser treatments (HPV negative, 2025-4-15)\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6877258/v1/8b7fac8e48127d3d6fbf97e5.jpeg"},{"id":87894786,"identity":"a8a25a26-5967-44d8-b878-8b1ff6f7c1a1","added_by":"auto","created_at":"2025-07-30 07:21:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2091870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6877258/v1/3ba779fa-4e67-4bc8-9d0a-20d21a445cd4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnosis and treatment of postoperative high-grade vaginal lesions in a case of cervical malignant tumor","fulltext":[{"header":"1 Case report","content":"\u003cp\u003eA 51-year-old female patient was admitted to the hospital due to \"vaginal lesions found 1 month after 3 years of cervical malignant tumor surgery\".LMP: April 5, 2021, regular menstruation, 1-0-0-1, normal labor, no history of co-bedroom hemorrhage and abnormal hemorrhage, no history of special diseases and surgery, denied history of drug allergy.In 2021, he went to the local hospital due to \"vulvar pain and vulvar herpes for 1 week\", and the examination showed HPV16 positive. TCT suggested ASCUS, colposcopy suggested SCJ type 3, and the proposed diagnosis was cervical HSIL. Biopsy pathology suggested HSIL involved glands (cervical 4 points), local early infiltration, and HSIL involved glands (cervical 6 and 9 points). Local squamous cell hyperplasia on the left side of vagina.2021-5-18 He went to the Cancer Hospital Affiliated to Fudan University for diagnostic cervical conization and cervical scraping. Postoperative pathology revealed invasive carcinoma of the cervix, some squamous cell carcinoma, depth of invasion 8mm in conization tissue, vascular invasion (-), invasive carcinoma of the incisal margin. ECC breaks up cancerous tissue, mucus and cervical mucosa. Advise hospitalization for further surgical treatment.On May 27, 2021, the patient was admitted to Fudan University Cancer Hospital and underwent radical hysterectomy, retroperitoneal lymphadenectomy, bilateral salpingo-oophorectomy, and para-aortic lymph node dissection. Postoperative pathology revealed: ① An exophytic\u0026thinsp;+\u0026thinsp;endophytic tumor measuring 4.5 \u0026times; 2.5 \u0026times; 1.5 cm; ② Histological type: Non-keratinizing squamous cell carcinoma; ③ Depth of invasion: Full-thickness involvement of the cervical fibromuscular wall with adjacent organ invasion, making pathological assessment difficult; ④ Vascular tumor emboli: Extensive (+), perineural invasion (-). Left parametrial tissue: Vascular tumor emboli. Right parametrial tissue: Vascular tumor emboli. Vaginal margin (-); ⑤ Uterine corpus: Endometrium exhibited secretory-phase morphology, with two intramural leiomyomas measuring 0.5 cm and 1 cm in diameter. Bilateral adnexa: No evidence of metastatic carcinoma;⑥Lymph node status: (6/23) (metastatic/total), with carcinoma metastasis identified. Left pelvic (1/6), right pelvic (1/8), left common iliac (2/4), right common iliac (0/1), para-aortic (0/1), right parametrial (2/3).Postoperative treatment included 28 sessions of pelvic radiotherapy, 4 cycles of DDP chemotherapy, and 4 cycles of paclitaxel combined with carboplatin chemotherapy.In the 2022 follow-up examination, no significant abnormalities were detected in the complete blood count, liver and kidney function tests, tumor marker SCC levels, or pelvic CT scan.In March 2023, the patient visited Fudan University Shanghai Cancer Center. Tumor markers were within normal range. HPV testing showed positive for types 31, 56, 53, 43, and 54. TCT results indicated ASCUS. Colposcopic evaluation revealed post-radiotherapy changes, and no biopsy was performed. The patient was advised to undergo regular follow-up.Visited Fudan University Shanghai Cancer Center on April 9, 2024. HPV testing showed positive for types 18, 53, 6, 43, 54, and 81. TCT result indicated ASC-H. Colposcopy revealed post-radiotherapy vaginal changes with tissue rigidity and pale mucosa, suggestive of vaginal HSIL. Biopsy pathology confirmed HSIL at the vaginal stump. Pelvic MRI demonstrated postoperative uterine changes with normal SCC levels. Referral to the Cervical Disease Department of Obstetrics and Gynecology Hospital of Fudan University was recommended for further treatment.Visited the Cervical Department of Obstetrics and Gynecology Hospital affiliated to Fudan University on June 5, 2024. Physical examination showed stable vital signs, with no abnormalities detected on cardiopulmonary auscultation. The abdomen was soft and non-tender without rebound tenderness. Gynecological examination revealed a married-type vulva, patent vagina with slight shortening, well-healed vaginal stump, rigid and congested mucosal tissue that bled easily upon contact. Ancillary tests: Fudan University Shanghai Cancer Center HPV test: positive for types 18, 53, 6, 43, 54, and 81. TCT: ASC-H. Colposcopy-guided biopsy pathology: HSIL at the vaginal stump. Pelvic MRI: post-hysterectomy changes, normal SCC. Estrogen cream was applied vaginally for 14 days for preparation, followed by colposcopic evaluation. Findings included vaginal mucosal bleeding and rigidity. Preliminary diagnosis: vaginal HSIL and vulvar LSIL. Vulvar biopsy was performed(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Pelvic contrast-enhanced MRI indicated post-hysterectomy changes with bilateral inguinal lymphadenopathy (largest node approximately 1 cm), recommended for follow-up. Currently, no evidence of vaginal invasion was observed. After thorough discussion with the patient and family, considering the poor response to CO2 laser therapy post-pelvic radiotherapy and the presence of multiple vaginal lesions, fractional laser therapy was proposed, supplemented by topical Patelin treatment postoperatively. The risks of recurrence and potential malignant transformation were clearly communicated.2024-06-05 On July 16, 2024 and November 8, 2024, laser surgery for vaginal lesions was performed. On November 8, 2024 and January 3, 2025, laser surgery for vaginal\u0026thinsp;+\u0026thinsp;vulvar lesions was performed༈Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e༉. After surgery, Paitalin was given vaginally. Sexual life was strictly prohibited. Vaginal ultrasound was followed up regularly. Blood routine, liver and kidney function and SCC showed no obvious abnormality.2025-03-14 Reexamination in Fudan University Recurrent Obstetrics and Gynecology Hospital showed HPV negative, TCT: NILM, pelvic CT suggested changes after hysterectomy. Estrogen vaginal preparation 14 days, colposcopy: vaginal mucosa pink, elasticity than before significantly improved, vinegar white staining vaginal mucosa significantly less bleeding, suspected diagnosis: inflammatory changes, biopsy pathology: (vaginal apex tissue) a small amount of free squamous epithelial tissue༈Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e༉. Post-operative education was given, and it was suggested to reexamine it six months later.\u003c/p\u003e"},{"header":"2 Colposcopy images and laser treatment images","content":"\u003cp\u003eFigure 1, 2 and 3 are belongs here.\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003e3.1 Vaginal intraepithelial neoplasia (VaIN), also known as vaginal squamous intraepithelial lesion (vaginal SIL), refers to atypical proliferative diseases occurring in different degrees in the vaginal epithelium and closely related to human papillomavirus (HPV) infection\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. HPV persistent infection is the most important factor for VaIN occurrence and development. Studies have found that\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003eHPV is an independent risk factor for VaIN occurrence and prognosis. It has been reported in the literature that the detection rate of HPV in VaIN1 and VaIN2-3 is about 90%, and the detection rate in vaginal cancer is about 60%. The most common type is still HPV16, followed by 52, 58 and 53\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The peak age of VaIN was 35\u0026ndash;58 years old. The older the age, the higher the risk and grade of VaIN. The onset age was later than that of CIN\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Vaginal lesions were multicentric and multifocal, often involving the upper 1/3 of the vagina, often combined with CIN or CC. Therefore, patients with hysterectomy due to CIN or CC have a higher incidence of VaIN and are even more likely to develop high-grade VaIN or even vaginal cancer\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Due to the relatively low incidence of VaIN and vaginal cancer, most patients are asymptomatic and are detected only when referred to colposcopy due to abnormal cytology or HPV screening results, coupled with the fact that many colposcopists are inexperienced and do not realize the importance of vaginal lesions, do not perform colposcopy to assess vaginal conditions before hysterectomy, or do not regularly follow up vaginal lesions after hysterectomy, there are many missed patients.\u003c/p\u003e\u003cp\u003e3.2 Currently, the screening for VaIN still relies on cytology, HPV testing, and colposcopy, with biopsy of suspicious lesions under colposcopy remaining the gold standard for diagnosis\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Abnormal cytology/HPV screening results are the primary indications for colposcopy, particularly in the following scenarios, where vaginal lesions should be suspected: 1. Abnormal cervical screening results with no suspicious lesions detected on cervical evaluation\u0026mdash;a comprehensive assessment of the vaginal wall should be performed, focusing on the upper third and fornix. 2. Persistent HPV positivity or abnormal cytology after treatment for HPV-related diseases (e.g., cervical HSIL treated with cervical conization/LEEP or hysterectomy). 3. Follow-up after VaIN treatment. 4. Visible vaginal wall abnormalities or residual stump growths during gynecological examination. 5. Unexplained abnormal discharge, fluid leakage, bleeding, or postcoital bleeding. Colposcopy for VaIN also presents several challenges\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e: 1. The vaginal wall has numerous folds and high elasticity, making many lesions prone to concealment and difficult to fully expose under colposcopy (e.g., vaginal laxity, prolapse, or scattered lesions). In post-hysterectomy patients, lesions may hide in the lateral vaginal angles. 2. Inexperienced colposcopists may overlook fornix lesions, inadequately control biopsy depth, fail to obtain valid specimens, or cause excessive depth-related complications, including damage to adjacent organs\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. 3. Reduced estrogen levels in postmenopausal women may impair observation, with insufficient awareness of this effect\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. 4. In post-radiotherapy patients, vaginal shortening, loss of elasticity, and tissue rigidity increase the difficulty of lesion detection and biopsy risks.\u003c/p\u003e\u003cp\u003e3.3 The current treatment modalities for VaIN primarily include: pharmacological therapy (estrogen, imiquimod cream, traditional Chinese medicine preparations such as paiteling, baofukang suppository, etc.), physical therapy (CO₂ laser, electrocautery, photodynamic therapy, cryotherapy, etc.), surgical treatment (total vaginectomy, partial vaginectomy, local vaginal resection, etc.), and radiotherapy. Regardless of the treatment approach, VaIN carries the risk of lesion recurrence and progression, particularly in patients who have undergone hysterectomy due to CIN or CC, necessitating long-term and rigorous follow-up.Reportedly, the risk of vaginal LSIL progressing to vaginal cancer is relatively low, while the risk of vaginal HSIL progressing to invasive cancer is approximately 3.2\u0026ndash;5.8%, with an average progression time of 54\u0026ndash;61 months\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Therefore, combined cytology and HPV testing is essential, and abnormal screening results should prompt timely referral for colposcopy.The selection of VaIN treatment should be individualized, taking into account factors such as the patient's age, physical condition, medical history, lesion location, and the desire to preserve sexual function. Long-term management and close follow-up are required.\u003c/p\u003e\u003cp\u003e3.4 In this case, the patient underwent total hysterectomy due to cervical malignancy, followed by adjuvant chemoradiotherapy. Two years postoperatively, HPV testing revealed multiple infections, and colposcopy was performed without biopsy. The following year, persistent multiple HPV infections were detected, and colposcopy-guided biopsy confirmed vaginal HSIL. A retrospective analysis of potential high-risk factors for postoperative vaginal HSIL in this patient identified the following: ①Preoperative reassessment of vaginal involvement was not performed; ②Partial vaginectomy was not conducted during surgery; ③Postoperative HPV/cytological follow-up was not promptly intensified; ④Initial postoperative colposcopy did not include biopsy (due to atypical lesions post-pelvic radiotherapy, random biopsy could have been considered for exclusion); ⑤ Postoperative colposcopy should have been performed by an experienced physician. Based on the colposcopic findings and pathological results, invasive carcinoma was ruled out, and surgical or radiation therapy was not considered. Laser therapy was deemed feasible; however, due to pelvic radiotherapy, multifocal and scattered lesions, the vaginal epithelium exhibited poor responsiveness to laser, posing challenges such as suboptimal treatment efficacy, high recurrence rates, and potential risk of disease progression to invasive carcinoma. Fractionated laser therapy combined with traditional Chinese medicine (Pateling) for antiviral treatment was proposed. After obtaining informed consent from the patient and family, multiple sessions of vaginal and vulvar laser therapy were performed by a senior physician at our hospital, followed by regular intravaginal medication. After nine months, both cytology and HPV testing normalized. Colposcopic evaluation suggested inflammatory changes, and biopsy pathology revealed minimal free squamous epithelium, ultimately achieving complete negative results.\u003c/p\u003e\u003cp\u003eCurrently, there is no consensus on the treatment of VaIN. The therapeutic approaches mentioned in the article are all feasible and should be tailored based on individual patient conditions. Considering the relatively high risk of vaginal HSIL progressing to invasive cancer in this patient, particularly in association with CC, active intervention is recommended\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Laser therapy utilizes the high thermal effect generated by a CO₂ laser to vaporize tissue and promote squamous epithelial regeneration, thereby achieving lesion removal. It is suitable for clearly exposed lesions. The procedure does not require anesthesia, is convenient to perform, offers precise targeting, and allows for controlled depth with strong repeatability. It is associated with fewer complications, minimal intraoperative and postoperative bleeding, reduced postoperative discharge, and minimal local burning reactions, while preserving vaginal anatomy and function to the greatest extent. Given the patient's condition and physical factors, CO₂ laser therapy is a relatively safe, low-side-effect, and highly effective treatment option. The depth of laser treatment is directly correlated with its efficacy. Studies report that the average thickness of vaginal lesions at all levels is generally\u0026thinsp;\u0026lt;\u0026thinsp;1 mm\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Therefore, a treatment depth of 1\u0026ndash;1.5 mm (including the thermal necrosis zone) and a treatment margin of 3\u0026ndash;5 mm beyond the lesion are recommended. Excessive depth may lead to reduced vaginal elasticity, contracture, bleeding, delayed healing, or even vaginal fistula formation. Standardized laser therapy requires comprehensive colposcopic evaluation before treatment, particularly at the bilateral vaginal apex after total hysterectomy. If the apex cannot be fully exposed or is deeply hidden with potential lesions that cannot be ruled out, vaginoscopic evaluation, biopsy, or even treatment may be necessary\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This patient, being in an estrogen-deficient state, required vaginal estrogen preparation for at least two weeks (after excluding estrogen contraindications) prior to both colposcopy and laser therapy. The bilateral vaginal apex was clearly visible under colposcopy, eliminating the need for further vaginoscopy. It is important to note that post-hysterectomy patients with a thin vaginal apex (\u0026lt;\u0026thinsp;3 mm), especially after radiotherapy, are at risk of apex rupture and fistula formation. Preoperative vaginal ultrasound assessment of apex thickness is essential, and the importance of experienced physicians performing biopsies and surgeries should be reiterated. Due to the patient's poor physical tolerance and extensive lesion involvement, four laser sessions were administered for vaginal lesions and two for vulvar lesions, supplemented with local antiviral and mucosal repair therapy during the treatment period.\u003c/p\u003e\u003cp\u003e3.5 Currently, there are no specific drugs for pharmacological treatment. The drugs mentioned in the literature are those that have shown relatively favorable outcomes based on empirical use. The Chinese herbal preparation Paiteling discussed in this article is a pure herbal liquid formulation developed by the Chinese Academy of Sciences for topical application, wet compress, or diluted irrigation of the lower genital tract. It is primarily composed of heat-clearing and detoxifying herbs such as Sophora flavescens and Hedyotis diffusa, supplemented by corrosion-removing and insecticidal herbs like Brucea javanica and Cnidium monnieri, and is refined through modern scientific extraction processes\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Experimental studies have confirmed that Paiteling may inhibit the proliferation and migration of Ect1/E6E7 cells by suppressing the Wnt/β-catenin pathway and reduce the incidence of cervical cancer by downregulating the expression of E6/E7 oncogenes\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Mouse experiments have demonstrated that Paiteling can stimulate immune responses, enhance immune reactivity in mice, and thereby reduce the viral load of HPV in infected tissues[19]. Paiteling is a liquid formulation. For treating cervical and vaginal lesions, 1 mL of the undiluted drug should be drawn using a specialized pipette and injected into the vagina while maintaining a head-low, hip-high position for at least half an hour to ensure adequate absorption. The dosage and treatment cycle should be adjusted based on the patient's condition. In this case, the patient was administered the drug for four consecutive days per week (before bedtime) with a three-day rest period to allow for drug absorption and vaginal mucosal recovery. After multiple rounds of laser therapy combined with pharmacological treatment, this patient achieved an unexpected outcome of complete lesion resolution and HPV clearance, suggesting that the treatment of vaginal intraepithelial neoplasia (VaIN) should not be limited to a single therapeutic approach. Combination therapy may yield relatively better results. However, this report represents a single case, and the patient's good compliance and adherence to medical advice were contributing factors.\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eThe understanding, diagnosis, and treatment of vaginal HSIL still require heightened attention, further exploration, and rigorous management. As the detection rate of vaginal lesions gradually increases, the challenges faced by colposcopists also escalate. Regression of vaginal HSIL is rare, with high risks of recurrence and progression, necessitating effective doctor-patient communication, strict long-term follow-up, and management.\u003c/p\u003e\u003cp\u003eFor this patient with initial regression, a follow-up interval of 6 months is recommended, including TCT and HPV testing. If abnormalities are detected, referral for colposcopy is advised; if results are normal, repeat TCT and HPV testing after 12 months is suggested. After two consecutive negative screenings, the frequency may be reduced to annual combined screening. Any positive result or abnormal symptoms during this period should prompt referral for colposcopy, along with continued imaging (CT/MRI) and tumor marker evaluations.\u003c/p\u003e\u003cp\u003eIn summary, this article reports a case of successful reversal of vaginal HSIL, analyzing its etiology, diagnostic pitfalls, examination, treatment, and follow-up. The findings provide valuable clinical experience for diagnosis and treatment, offering a reference for the management of similar cases, which holds certain clinical significance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatement of funds\u003c/p\u003e\n\u003cp\u003eThis article is not funded and is for personal work experience sharing.\u003c/p\u003e\n\u003cp\u003eEthical Statement\u003c/p\u003e\n\u003cp\u003eThis study adhered to the relevant international and national ethical guidelines. Ethical approvals were obtained for human research, and participants provided informed consent.\u003c/p\u003e\n\u003cp\u003eIn human research, participants have provided written informed consent and the option to withdraw at any point. Data collection and processing adhered to privacy protection principles, with all personally identifiable information either deleted or encrypted.\u003c/p\u003e\n\u003cp\u003eWe commit to presenting the findings of this study with honesty, objectivity, and responsibility, ensuring that they are not altered or distorted in any manner that may mislead readers or undermine the study\u0026apos;s integrity.\u003c/p\u003e\n\u003cp\u003eRelease form\u003c/p\u003e\n\u003cp\u003eDear reviewers, I am writing this article to express my personal experience in the diagnosis and treatment of this disease and hope to get your support and approval. I hereby submit it in the form of a consent form. The following is my position and reasons on this issue:Cervical cancer is the second largest female death tumor in the world. Many cervical cancer patients neglect the importance of postoperative reexamination after surgery and ignore the possibility of postoperative vaginal lesions. After this report, the patient found vaginal HSIL, through active physical therapy and drug treatment, the final outcome of the disease was cured, preventing further aggravation and recurrence of the disease.Therefore, I firmly believe that patients with cervical cancer after surgery still need regular and close follow-up, alert to vaginal lesions and vulvar lesions subsequent occurrence, early detection and early treatment, thus improving life treatment.\u003c/p\u003e\n\u003cp\u003eConfirmation\u003c/p\u003e\n\u003cp\u003eI collected case information, picture editing, article writing and postoperative follow-up by Wang Pengcheng. I am the only contributor to the article. There is no conflict of interest.\u003c/p\u003e\n\u003cp\u003eDisclosure statement\u003c/p\u003e\n\u003cp\u003eThe authors reported no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003eData availability statement\u003c/p\u003e\n\u003cp\u003eThe case information involved throughout the article has been comprehensively incorporated into this published article.\u003c/p\u003e\n\u003cp\u003eStatement\u003c/p\u003e\n\u003cp\u003eAll personal information and case contents involved in this article, including medical history, diagnosis and treatment process, diagnosis and treatment pictures, pathological results, etc., were written after informed consent of patients, and patients agreed to publish the report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRountis A,Pergialiotis V,Tsetsa P,et al. Management options for vaginal intraepithelial neoplasia[J]. Int J Clin Pract,2020, 74(11):e13598. \u003c/li\u003e\n\u003cli\u003eJiahui Wei,Yumei Wu.Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Archives of Gynecology and Obstetrics[J] .2024, 310:1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eAo M,Zheng D,Wang J,,et al. A retrospective study of cytology and HPV genotypes results of 3229 vaginal intraepithelial neo plasia patients[J].J Med Virol,,2022,94（2）:737-744. \u003c/li\u003e\n\u003cli\u003eBoonlikit S,Noinual N. Vaginal intraepithelial neoplasia:A ret rospective analysis of clinical features and colpohistology[J].J Obstet Gynaecol Res,2010,36（1）:94-100 .\u003c/li\u003e\n\u003cli\u003eTidy J. The risk of vaginal cancer is associated with a history of cervical neoplasia[J].BJOG,2020,127(4):455. \u003c/li\u003e\n\u003cli\u003eRountis A,Pergialiotis V,Tsetsa P,et al.Management options for vagi nal intraepithelial neoplasia[J].Int J Clin Pract,2020,74(11): e13598.\u003c/li\u003e\n\u003cli\u003eBrown BH,Tidy JA. The diagnostic accuracy of colposcopy A review of research methodology and impact on the outcomes of quality assurance［J］. Eur J Obstet Gynecol Reprod Biol, 2019,240：182-186.\u003c/li\u003e\n\u003cli\u003eKesic V.Carcopino X,Preti M,et al. The European Society of Gynaecological Oncology（ESGO）,the International Society for the Study of Vulvovaginal Disease(ISSVD),the European Col lege for the Study of Vulval Disease(ECSVD),and the Euro pean Federation for Colposcopy(EF)consensus statement on the management of vaginal intraepithelial neoplasia[J].Int J Gy necol Cancer,2023,33（4）:446-461.\u003c/li\u003e\n\u003cli\u003eWei Lihui, Zhao Yun. Modern Colposcopy [M]. 3rd ed. Beijing: Peking University Medical Press, 2016: 5. \u003c/li\u003e\n\u003cli\u003eChinese Expert Consensus on the Diagnosis and Treatment of Postmenopausal Cervical Intraepithelial Lesions (2022 Edition) [J]. Oncology Progress, 2022, 20(14): 1405-1411. \u003c/li\u003e\n\u003cli\u003eSopracordevole F,Clemente N,Di Giuseppe J,et al. Clinical Characteristics and Long-Term Follow-up of Patients Treated for High-Grade Vaginal Intraepithelial Neoplasia：Results From a 20-Year Survey in Italy[J].J Low Genit Tract Dis, 2020,24(4):381-386. \u003c/li\u003e\n\u003cli\u003eKimMK,Lee IH,Lee KH. Clinical outcomes and risk of recur rence among patients with vaginal intraepithelial neoplasia:A comprehensive analysis of 576 cases[J].J Gynecol Oncol, 2018,29(1):e6. \u003c/li\u003e\n\u003cli\u003eChinese Association of Minimally Invasive and Non-invasive Medicine, Gynecologic Oncology Committee; Chinese Association for the Promotion of Health Science and Technology, Female Reproductive Tract Diseases Diagnosis and Treatment Branch; Chinese Association for the Promotion of Health Science and Technology, Oncofertility Branch. Expert Consensus on the Diagnosis and Treatment of Vaginal Intraepithelial Neoplasia (2020) [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(8): 722-728. \u003c/li\u003e\n\u003cli\u003eHodeib M,Cohen JG,Mehta S,et al. Recurrence and risk of progression to lower genital tract malignancy in women with high grade VAIN[J].Gynecol Oncol,2016,141(3):507-510. \u003c/li\u003e\n\u003cli\u003eCui C,Xiao Y,Lin E,et al. Precise Measurement of the Thick ness of Vaginal Intraepithelial Neoplasia[J］. J Low Genit Tract Dis,2022,,26(3):245-249. \u003c/li\u003e\n\u003cli\u003eChen Limei, Zhang Hongwei, Wang Qing, et al. Application of vaginoscopy in the diagnosis and treatment of occult high-grade squamous intraepithelial lesions at vaginal fornix angles[J]. Chinese Journal of Obstetrics and Gynecology, 2021, 56(8): 569-575. \u003c/li\u003e\n\u003cli\u003eLiu Lianhui, Qin Wenmin, Zhang Yingxue, et al. Meta-analysis of the efficacy of Paiteling in the treatment of high-risk human papillomavirus (HR-HPV) infection. Chinese Traditional and Herbal Drugs. 2021, 52(22):6928-6938. \u003c/li\u003e\n\u003cli\u003eLiu Y H, Zhao Z J, Zhang X X, et al. Effects of Paiteling on Proliferation, Migration and PI3K/Akt Signaling Pathway in HeLa Cells. Chinese Journal of Experimental Traditional Medical Formulae, 2020, 26(17): 56-63. \u003c/li\u003e\n\u003cli\u003eXu R. Effects of five drugs on immune responses in a nude mouse model of HPV infection. Tianjin: Tianjin Medical University, 2019.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6877258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6877258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA case of cervical malignant tumor complicated with vaginal lesions 3 years after operation is reported. The patient was HPV16 positive before operation, biopsy showed cervical squamous cell carcinoma stage IB2, after corresponding surgical treatment and adjuvant chemotherapy, HPV multiple positive infections were reexamined 3 years after operation, biopsy showed vaginal HSIL and vulvar LSIL. After fractional laser surgery combined with petrin treatment, the result was finally HPV negative and the condition was cured.\u003c/p\u003e","manuscriptTitle":"Diagnosis and treatment of postoperative high-grade vaginal lesions in a case of cervical malignant tumor","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-30 07:05:41","doi":"10.21203/rs.3.rs-6877258/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-18T10:49:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-20T07:50:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256785960866905720668158277658791515586","date":"2025-09-20T07:21:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-04T09:31:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328405385085966153053280012999387176425","date":"2025-09-02T09:20:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112560505896589709954101893284487583957","date":"2025-08-14T14:59:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-28T05:26:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-20T14:45:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T06:44:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-06-19T06:41:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"407a74bc-5975-49f0-a304-60853358e00d","owner":[],"postedDate":"July 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T09:53:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-30 07:05:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6877258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6877258","identity":"rs-6877258","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}