A case of non-functioning vaginal paraganglioma
Paragangliomas are rare neuroendocrine tumors associated with the sympathetic and parasympathetic system. While they are known to occur anywhere in the body, they rarely affect the female genital tract.

Published in the Journal of Obstetrics and Gynaecology of India, the authors present a case of an 18-year-old female who presented with abnormal vaginal bleeding and was found to have a non-secretory vaginal paraganglioma.

An 18-year-old female presented with episodes of increased vaginal bleeding over a period of 2 months. She did not complain of bleeding from any other site and had no previous or family history of coagulopathy or bleeding disorders. On examination, her vitals were normal, but she was found to be pale. No mass was palpated.

Laboratory investigations revealed a hemoglobin level of 5.5 g/dL. Ultrasound (USG) of the pelvis and abdomen was performed and was unremarkable. The patient received blood transfusions. MRI of the pelvis was ordered which revealed a heterogenous polypoid lesion within the vaginal cavity measuring about 3 × 1.6 cm. No extension into cervix or surrounding tissues was seen.

A biopsy of the lesion was taken and revealed features suggestive of a well-differentiated neuroendocrine tumor, with sparse mitotic activity and mild ulceration of the overlying mucosa. Computed tomography (CT) imaging of the chest and abdomen was unremarkable, with no evidence of metastasis or a primary elsewhere. Urinary catecholamines and fractionated metanephrines were also normal. The patient was taken for surgery, and the mass was completely enucleated, en bloc.

Histological sections of the mass showed tumor cells arranged in nests, separated by thin fibrous septa with granular cytoplasm and minimal nuclear pleomorphism. On immunohistochemistry (IHC), the tumor was positive for synaptophysin, chromogranin and negative for desmin, CD163 and AE1/AE3, an epithelial cell marker. A low Mib-1 score of 3–4% was reported. A diagnosis of non-functioning vaginal paraganglioma was made.

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