Post-hysterectomy carcinoma of the fallopian tube mimicking a vesicovaginal fistula.

A 49-year-old woman presented with a profuse watery vaginal discharge 16 years after a vaginal hysterectomy. Pelvic examination revealed clear fluid leaking from the vaginal apex. Cytologic evaluation of the draining fluid was normal, as was a biopsy of the vaginal apex. A vesicovaginal fistula was suspected. Intravenous pyelogram and cystogram did not reveal communication of the urinary tract with the fistula. Injection of radiopaque dye through the fistula tract demonstrated a 5-7-cm enclosed cystic space with a 4-cm pedunculated mass within the cyst lumen. Exploratory surgery revealed fallopian tube carcinoma involving the right tube. The tumor mass was completely excised, and there was no evidence of spread beyond the encapsulated cystic fallopian tube. The woman was treated with six cycles of cisplatin combination chemotherapy, and after 5 years remains free of disease.