Abstract
Although radiotherapy is an integral part in the management of certain types of hematological
malignancies, its effect on the reproductive system has been well documented. We report
a rare complication where a patient had complete vaginal obliteration after receiving
a dose of total body irradiation (1575 cGy) as part of her treatment for acute myeloid
leukemia. A 37-year-old married woman, G3P2, underwent high-dose cyclophosphamide
accompanied by high dose (1575 cGy) total body irradiation (TBI) as part of her treatment
for acute myeloid leukemia (AML: m1) when she was 35 years of age. After TBI, the
patient developed ovarian failure and amenorrhea, which was confirmed by hormonal
evaluation. Nevertheless, she did not receive any hormonal replacement therapy and
stopped her sexual life for two years. Fortunately, no recurrence of AML was noted.
The patient visited our clinic due to difficulty in performing coitus. Physical examination
showed a 2-cm short and blinded vaginal pouch. She initially received hormonal replacement
therapy followed by surgical correction via vaginoplasty and two months of dilatory
replacement and frequent coitus with satisfactory result. To our limited knowledge,
vaginal obliteration as a complication of condition regimen has never been reported
before. In the present case report, it is unclear whether spontaneous vaginal obliteration
resulted from chemotherapy, total body irradiation, or another unknown cause such
as a concomitant leukemic infiltration of the vaginal wall, severe bacterial and fungal
infection before treatment, or from any combination of the above. However, due to
this case presentation, we suggest that such patients must receive hormonal replacement
therapy and be encouraged to have a normal sexual life to avoid this possible problem.
Keywords
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References
- Endocrine and reproductive dysfunction following fractionated total body irradiation in adults.Q J Med. 1991; 287: 265-274
- Gonadal complications.in: Armitage J. Antman K. High dose cancer therapy. Williams and Wilkins, Baltimore, MD1992: 555-566
- Ovarian failure following abdominal irradiation in childhood: natural history and prognosis.Clin Oncol. 1989; 1: 75-79
- Handbook of radiobiology. second ed. CRC Press, New York1995
- Cyclophosphamide-induced ovarian failure.New Engl J Med. 1973; 289: 1159-1162
- Ovarian function following bone marrow transplantation for aplastic anemia or leukemia.J Clin Oncol. 1988; 6: 813-818
- Successful pregnancy in a woman with acute myeloid leukemia treated with high-dose whole-body irradiation.J Reprod Med. 1998; 43: 803-806
- Ovarian function after successful bone marrow transplantation in post menarchal females.Med Paed Oncol. 1983; 11: 361-364
- Growth and development after bone marrow transplantation.in: Forman S.J. Blume K.J. Thomas E.D. Bone marrow transplantation. Blackwell Scientific, Boston, MA1993: 527-537
Nichols DH, Randall CL. Vaginal surgery, fourth ed. Baltimore: Williams & Wilkins, 1998.
- Human radiation biology. Harper and Row, New York1974
- Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte.Br J Radiol. 1989; 62: 995-998
- Growth and development after bone marrow transplantation.in: Forman S.J. Blume K.J. Thomas E.D. Bone marrow transplantation. Blackwell Scientific, Boston, MA1993: 527-537
- Castration of the female by irradiation: the result in 334 patients.Radiology. 1940; 34: 176
- Gonadal damage and effects on fertility in adult patients with haematological malignancy undergoing stem cell transplantation.Bone marrow transplantation. 1996; 17: 5-11
- Evaluation of short and long term effects of TBI Vs BEAM on H–P–G axis in patients with hematological malignancies (abstract).Br J Haematol. 1993; 84: 52
Article info
Publication history
Accepted:
July 20,
1999
Received in revised form:
June 2,
1999
Received:
April 1,
1999
Identification
Copyright
© 2000 Elsevier Science Ireland Ltd. Published by Elsevier Inc. All rights reserved.
