The Diagnostic Conundrum of Recurrent High-Grade Vaginal Intraepithelial Neoplasia (VAIN) Following Definitive Cervical Cancer Treatment: A Case Report

Background: Cervical cancer management can be complex, particularly in cases with aggressive histopathology and atypical recurrence patterns. This report details the course of a patient with high-grade cervical carcinoma. Case Presentation: A 43-year-old female was initially diagnosed with a high-grade squamous intraepithelial lesion (HSIL) on biopsy. Following laparoscopic hysterectomy, final pathology revealed upstaging to FIGO stage pT1b2, Grade 3 squamous cell carcinoma (SCC). The patient received adjuvant concurrent chemoradiotherapy (CCRT) with Cisplatin. Initial surveillance was clear, but she later presented with neurological symptoms and an abnormal Pap smear, leading to a diagnosis of high-grade vaginal intraepithelial neoplasia (VAIN). Subsequent imaging confirmed disease recurrence with peritoneal metastasis. Conclusion: This case underscores the aggressive biological behavior possible in certain cervical carcinomas, even after standard definitive treatment. It highlights the diagnostic challenges of recurrence, including transiently benign biopsies, and emphasizes the need for vigilant, multimodal surveillance in high-risk patients.