A 52-year-old woman presented from an outside hospital after syncope. The patient had a 2-day history of heavy vaginal bleeding passing large clots and suprapubic pain. She denied any vaginal pain, dysuria, hematuria, or frequency. She had a remote history of a total abdominal hysterectomy and bilateral salpingo-oophorectomy secondary to leiomyomata.
The initial pelvic examination revealed blood clots in the vagina along with a friable, fibrous ulcerated lesion on the anterior suburethral vagina, just left of the midline measuring 4 × 2cm. The lesion was actively bleeding and necrotic, but did not appear to extend beyond the sidewall. Biopsies of the specimen were insufficient for diagnosis revealing blood and necrotic material. A computed tomography scan revealed a soft tissue mass within the lumen of the vagina and an enlarged lymph node located within the right ovarian chain (Image).…