Hematocolpos as a complication of chronic graft-versus-host disease

Allogeneic hematopoietic stem cell transplantation (AHSCT) is being used to treat hematological malignancies with increasing frequency. AHSCT has many complications, such as infections, veno-occlusive disease of the liver, drug reactions, and graft-versus-host disease (GvHD). Pathogenesis of GvHD is believed to be a complex immune response, primarily T-cell mediated, in which the grafted donor cells recognize the host as foreign. GvHD can involve the skin, gastrointestinal tract, lungs, and liver [1]. It is a difficult-todiagnose disease that gynecologists may not be familiar with. Our case gives guidance on the prevention and management of the gynecologic complications of GvHD. A 44-year-old, gravida 2, para 2 woman had been diagnosed with chronic myeloid leukemia 4 years earlier, and was treated with imatinib and hydroxyurea for 1 year. She had also suffered from dysmenorrhea 4 years earlier and had a 3 2 cm left ovarian cyst that suggested endometriosis. After entering complete remission, she underwent AHSCT. One year after the AHSCT, she developed chronic GvHD with pulmonary organ involvement and began menopause. Her laboratory findings revealed a follicle-stimulating hormone level of 49 IU and estradiol (E2) of 19. Sequential hormone replacement therapy was introduced for the menopause symptoms. Subsequently, she presented with a 5-day history of abdominal pain. Clinical examination revealed extensive vulvar atrophy with flattening. She had almost complete obstruction of the entire vaginal canal (Fig. 1). Vaginal biopsies revealed chronic nonspecific inflammation with fibrosis. We performed the human papillomavirus (HPV) DNA chip test to screen for precancerous risk factors. The test was positive for HPV (other type) in the vagina. Vaginal stenosis limited the ability to perform a routine Papanicolaou test and