We report a case of vaginal cancer that developed 1 year after total laparoscopic hysterectomy (TLH) and reconstruction of the anterior vaginal wall (RAVW) for pelvic organ prolapse (POP) and cervical intraepithelial neoplasia 3 (CIN3). A 56-year-old woman had received pessary treatment for POP since the age of 46. Cervical dysplasia was suspected at the age of 51, and the woman was followed up every 4-6 months. The dysplasia progressed to CIN3, and TLH and RAVW were therefore performed after conization ruled out invasive cancer. A uterine manipulator was used for hysterectomy. Pathological examination confirmed the diagnosis of CIN3. The patient skipped her follow-up visit at 6 months, and returned to us due to persistent vaginal bleeding at 1 year. A 3-cm-diameter tumor was found in the anterior vaginal wall. Squamous cell carcinoma was detected by biopsy, and pelvic lymph node metastases were suspected on the basis of MRI. Concurrent chemoradiotherapy was planned as treatment. A multicenter clinical trial of cervical cancer compared radical hysterectomy (RH) via minimally invasive surgery (MIS) vs. an abdominal approach, and showed that MIS was associated with a higher rate of local recurrence. This may have been because MIS caused tumor spillage due to the use of a uterine manipulator, and increased tumor-cell growth or spread resulting from CO2 insufflation. Although the patient in the present case had CIN3, we hypothesize that chronic inflammation due to pessary treatment and surgical intervention for RAVW may also have enhanced carcinogenesis.
