Primary malignant melanoma of the cervix (PMMC) is an exceptionally rare and aggressive malignancy with a poor prognosis. Due to its rarity, there are no standardized treatment guidelines. This case report presents two patients with PMMC, contributing to the literature through a novel treatment approach and literature review. Both patients presented with vaginal bleeding: one postmenopausal without obvious cervical pigmentation, the other premenopausal with a brown, friable cervical mass. Histopathology confirmed PMMC in both. The first patient underwent radical surgery without adjuvant therapy and died from recurrence 36 months later. The second patient received radical surgery, adjuvant chemotherapy, and bevacizumab maintenance, followed by a combination of carboplatin, dacarbazine, and Tislelizumab for pulmonary metastases, achieving significant tumor regression after two cycles. A review of nine reported cases treated with PD-1/PD-L1 inhibitors revealed that radical surgery was performed in 90% of patients, yet 80% did not receive chemotherapy or radiotherapy, and most (80%) still experienced disease progression with immunotherapy, underscoring its limited efficacy. PD-L1 expression, assessed in only three cases (all negative), did not reliably predict response. In conclusion, PMMC remains a formidable clinical challenge with high recurrence rates despite surgery. Response to immune checkpoint inhibitors is inconsistent, but multimodal strategies integrating surgery, chemotherapy, anti-angiogenic agents, and immunotherapy may offer clinical benefit and warrant further investigation to improve outcomes in this aggressive disease.

Vaginal foreign bodies (VFBs) can affect women of all ages, but they are most frequently observed in the pediatric population. Such cases are relatively uncommon in women of reproductive age and postmenopausal women, and the long-term retention of foreign bodies in adults is particularly rare. We report a case of a 53-year-old postmenopausal woman with a history of bipolar disorder and autism spectrum disorder who presented with persistent vaginal bleeding, discharge, and foul odor for one year. She admitted to inserting various objects into her vagina annually since her early 30s. Imaging (ultrasound and CT) revealed multiple hyperechoic structures within the vaginal canal. Hysteroscopic examination demonstrated extensive inflammatory hyperplasia and polypoid lesions. A total of 13 foreign bodies, including porcelain bottles, a button, medicine bottles, and candy wrappers, were successfully retrieved. Postoperative histopathology confirmed benign inflammatory changes, ruling out malignancy. The patient recovered uneventfully. This case highlights the diagnostic challenges and management of long-term retained VFBs in postmenopausal women with psychiatric comorbidities. It underscores the need for a high index of suspicion in such patients presenting with non-specific gynecological symptoms to prevent severe complications.

This report describes a rare presentation of embryonal rhabdomyosarcoma (ERMS) in a 76-year-old postmenopausal woman who presented with several months of unreported vaginal bleeding followed by obstructive urinary symptoms. Imaging revealed a large uterine mass, and biopsy with immunohistochemical staining confirmed ERMS characterized by high-grade histopathologic features. Given her advanced age, comorbidities, poor functional status, and extensive tumor burden, the patient opted for palliative care focused on comfort and quality of life. This case highlights the diagnostic challenges, aggressive nature, and poor prognosis associated with adult ERMS. It reinforces the importance of promptly evaluating postmenopausal bleeding and raising clinician awareness to facilitate earlier diagnosis and improve outcomes in elderly patients.

Low-risk human papillomavirus (HPV) types are traditionally regarded as non-oncogenic and are primarily associated with benign epithelial proliferations. Invasive cervical squamous cell carcinoma (CSCC) related to low-risk HPV infection is exceedingly rare. Here, we report a rare case of HPV6-associated CSCC in a postmenopausal woman and comprehensively characterize its clinicopathological, immunophenotypic, and molecular features, with a review of the relevant literature. The patient presented with irregular vaginal bleeding and an exophytic cervical mass. Histopathological examination revealed verrucous papillary squamous epithelial hyperplasia with prominent fibrovascular cores, surface koilocytosis, marked cytological atypia, and focal superficial stromal invasion (≤ 3 mm). Immunohistochemical analysis demonstrated negative p16 expression and a high Ki67 proliferation index. HPV genotyping detected isolated low-risk HPV type 6, with no evidence of high-risk HPV infection. Targeted next-generation sequencing identified multiple somatic alterations, including pathogenic mutations in TP53, CDKN2A, TERT promoter, and LATS1, suggesting a host-driven molecular carcinogenic process. The present study supports an indirect carcinogenic pathway for low-risk HPV-associated cervical squamous cell carcinoma, in which persistent viral-induced epithelial proliferation may facilitate the accumulation of oncogenic host mutations. Recognition of this rare entity expands the pathological spectrum of HPV-associated cervical cancer and underscores the importance of integrating morphology, immunohistochemistry, and molecular testing for accurate diagnosis and risk assessment.Awareness of this rare entity may help avoid underdiagnosis of malignant transformation in exophytic cervical lesions associated with low-risk HPV infection.

Urethral prolapse is defined as the protrusion of the distal urethral mucosa in a circular shape through the external meatus. It is a rare condition with an estimated incidence of 1 in 3,000 cases. It primarily affects prepubescent girls of African origin and postmenopausal women of Caucasian origin. While generally asymptomatic, this condition can also cause vaginal bleeding, dysuria, hematuria, urinary urgency, urinary retention and dyspareunia. The pathophysiology of this condition is debated. Increases in intra-abdominal pressure (e.g. coughing, constipation or trauma) and a hypo-estrogenic environment are the most common risk factors. In most cases, the diagnosis is clinical. It is important to consider the differential diagnosis, as this condition can include malignant pathologies (such as botryoid sarcoma and rhabdomyosarcoma), as well as sexual violence. Treatment is generally conservative for asymptomatic or paucisymptomatic cases, while more symptomatic or recurrent cases may benefit from surgery. This article presents the case of a three-year-old girl of African origin who was referred to the local Sexual Assault Center (SAC) for suspected sexual abuse, after vaginal bleeding of unknown origin was discovered upon her return from school.

Gastric-type endocervical adenocarcinoma (G-EAC) is an uncommon human-papillomavirus-independent cervical malignancy that frequently presents with non-specific symptoms and carries a high risk of peritoneal dissemination. A 52-year-old postmenopausal woman presented with 10 days of spontaneous, irregular, vaginal bleeding of moderate volume. She denied abdominal pain, tenesmus, or constitutional symptoms. Tumor markers showed elevation of CA-125 (212.37 U/mL) and CA-199 (1793.93 U/mL). The patient underwent MRI examination, which showed isointense signal intensity on T1-weighted imaging (T1WI) and slightly higher signal intensity on T2-weighted imaging (T2WI) in the cervix, with a size of approximately 49 mm × 45 mm × 48 mm. The boundary with the adjacent uterine cavity was unclear, suggesting a cervical tumor lesion. The patient underwent further PET/CT examination, which revealed a soft-tissue cervical mass with mild to moderate [18]F-FDG uptake with an SUVmax of 5.4, diffuse and nodular thickening of the greater omentum, peritoneum, and mesentery showing mild uptake with an SUVmax of 2.2, accompanied by abdominal and pelvic fluid accumulation. The patient underwent histopathological examination of cervical mass tissue, and the pathological diagnosis was primary gastric adenocarcinoma of the cervix. [18]F-FDG PET/CT can comprehensively evaluate the whole body, detect distant lesions, and provide an accurate diagnostic basis. Therefore, it holds significant diagnostic value for G-EAC, which is relatively rare and easily overlooked in clinical practice. It can help nuclear medicine physicians avoid misdiagnosis or missed diagnosis.

Chronic uterine inversion is a rare disease presentation in obstetrics and gynecology discipline. It is the descent of uterine fundus inside out through the cervix. It is grossly classified as puerperal and non-puerperal uterine inversion. Non-puerperal uterine inversion is reported in 16% of all uterine inversions. Actual prevalence of puerperal uterine inversion is difficult to estimate in developing countries but estimated to be 1 in 20,000-50,000 cases. Chronic uterine inversion is commonly associated with other uterine pathology, mainly submucous uterine leiomyoma. Endometrial polyp, uterine sarcoma, previous repositioned inverted uterus and increased abdominal pressure are other associated factors. Abnormal vaginal bleeding, mass per vagina, foul-smelling vaginal discharge and lower abdominal pain are frequent clinical symptoms. Uterine inversion is frequently misdiagnosed as uterine prolapse due to anatomical and symptom similarity. Physical examination, radiologic imaging and high index of suspicion help to diagnose and differentiate from uterine prolapse. Abdominal, vaginal or laparoscopic approaches are possible methods of treatment depending on the surgeon's experience. In abdominal and laparoscopic approaches, uterine repositioning prior to surgery is mandatory, either manual or surgical repositioning. Fifty years old, para 6, woman presented with chief complaint of mass per vagina of 3 months duration. It was associated with lower abdominal pain, vaginal bleeding and offensive vaginal discharge. She had intermittent low grade fever since the last one 1 month. On physical examination, she was tachycardic (pulse rate = 110) and febrile (temperature = 37.6°C centigrade). On HEENT examination, her conjunctiva was pale. On genitourinary system examination, there was offensive vaginal discharge, large mass protruding through vagina with 15 × 12 cm sized mass attached to uterus by broad pedicle. Overlying tissue was necrotic and fragile that bleeds easily. Cervix was not palpable. She was investigated with blood tests and abdominal ultrasound. Chronic uterine inversion with pedunculated leiomyoma severe anemia were diagnosed. After stabilizing the patient with transfusion and antibiotics, abdominal hysterectomy was done after uterus placed into abdomen surgically, as manual repositioning was difficult. Haultain's technique was used to reposition uterus into abdomen. Post-operative course was smooth and she was discharged home with improvement. Two weeks after discharge, she visited gynecologic out-patient department and it was smooth course. Chronic uterine inversion is a rare disease. It is grossly classified as puerperal and non-puerperal uterine inversion. Pelvic pathologies like leiomyoma, endometrial polyps, uterine neoplasms, and large bladder stones are predisposing factors. It is frequently misdiagnosed as uterine prolapse. Frequently, physical examination, common radiologic imaging like ultrasound, and a high index of suspicion are adequate to reach a diagnosis. In limited cases, like grade 1 and 2 uterine inversion, patients with no risk factors and adolescents, advanced diagnostic imaging like MRI and CT scans are recommended. Surgical intervention is the primary management, either for uterine preservation or hysterectomy. Although there is no recommended standards of operation approach, Adnominal, laparoscopic or vaginal approaches are possible option of surgical route depending on surgeon's experience. Chronic uterine inversion is a rare disease entity. It has diagnostic and treatment challenges. It is commonly misdiagnosed as uterine prolapse. A high index of suspicion is crucial during the evaluation of a patient presenting with protrusion of mass per vagina as uterine prolapse mimics uterine inversion. There is no standardized surgical management. Surgical approach, either abdominal. Vaginal or laparoscopic, depends on surgeon's experience.