Vaginal cancer in the second trimester of pregnancy: Successful conservative surgery and 21-year disease-free survival

Introduction Primary vaginal cancer during pregnancy is exceedingly rare, and management is not standardized. Treatment requires balancing maternal oncologic outcomes with fetal preservation in the context of limited evidence. Case: A 38-year-old woman was diagnosed in the second trimester of pregnancy with a 4 cm anterior vaginal lesion. Biopsy showed a Müllerian-type adenocarcinoma with mucinous differentiation associated with HPV-16 infection. Staging revealed no metastatic disease. Following multidisciplinary counselling, extensive surgical excision was performed at 23 + 6 weeks of gestation. Final pathology after surgical excision of the remaining tumor demonstrated microinvasive squamous cell carcinoma with associated high-grade intraepithelial lesions and areas of adenocarcinoma in situ. Pregnancy continued, and a healthy infant was delivered at 36 + 6 weeks. Postpartum intraepithelial recurrence was successfully treated. At 21 years and six months of follow-up, the patient remains disease-free. Conclusion Conservative surgical management during pregnancy may be feasible in carefully selected patients. Complete surgical excision remains essential for accurate diagnosis and treatment. Multidisciplinary, individualized decision-making is required.