Snap Shot A 62-year-old women, gravida 4, para 4, complains of abnormal vaginal bleeding that occurs intermittenly between her predictable menstrual cycles. Vaginal biopsy showed a malignancy and an operation was performed. Introduction Vaginal cancer accounts for 1% of gynecologic malignancies in the USA Several types squamous cell 95% of vaginal malignancies risk factors history of human papillomavirus infection cervical or vulvar cancer diagnosis is often at 60-65 years clear cell adenocarcinoma risk factors exposure to diethylstilbestrol in utero inhibitor of Mullerian differentiation also results in uterine malformations and cervical incompetence mean age at diagnosis of this rare malignancy is 19 yrs Sarcoma botryoides (embryonal rhabdomyosarcoma) grape-like mass in young girls (< 4 years) can prolapse out of vagina spindle-shaped tumor cells stain positive for desmin Presentation Symptoms abnormal vaginal bleeding may be postcoital, intermenstrual, or postmenopausal. watery vaginal discharge dyspareunia Evaluation Biopsy most lesions occur in the upper 1/3 of the vagina Treatment Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor surgery raditation chemotherapy