In her medical background we found a bifid kidney, a hysterectomy in 2016 (for fibroma), 1 delivery in 1993 and 2 abortions. Her first periods appeared at 12 and her menopause at 51 years old. The last Pap smear, done in 2016, was normal.
During the interrogation, she reported an alteration of the general condition (weightloss, asthenia) associated with cough and serous sputum since 1 or 2 years. She also suffered from pelvic pain, vulvar itching or burning, vaginal discharges, urinary frequency and burning.
The global examination (neurological, cardiological, pulmonary, breast and abdominal) was normal. At the pelvic floor, vulva seemed intact but the anterior surface of vagina and cervix was inflammatory. We practiced a Pap smear and vaginal biopsies.
The vaginal touch revealed an indurated and painful mass (Fig. 1). There was one inguinal lymph node palpable.
Concerning complementary exams: the pap smear was normal and vaginal biopsies revealed ulcerative cervicitis lesions with partially necrotizing gigantocellular epihtelioid granuloma. There was no atypical or dysplastic lesions associated (Fig. 2).
Please note that in our case, the diagnostic had probably been delayed because the operative report of hysterectomy in 2016 mentioned a non-necrotizing gigantocellular epihtelioid granuloma, evoking sarcoidosis in the first place.
Search for BK by culture and PCR was positive on vaginal biopsies and urinary sample; it reveled a Mycobacterium of the tuberculosis complex.
We searched for a pulmonary damage associated: direct examinations on sputum, gastric tubage and bronchoalvelar lavage were negative. During the bronchial fibroscopy, we did not see any ENT chain or bronchial tree abnormalities.
The biological checkup was normal except a minim inflammatory syndrome (CRP at 35 mg/L and leucocytes at 10,6 G/L). ELISPOT  test was positive unlike HIV, HCV and HBV test.
Extension had been assessed using a TAP scanner: it revealed a right lobar mass with spicules, multiples bilateral micronodules, diffuse emphysema and a thickening of the interlobular septa (Fig. 3). There was no anomaly on the pelvic floor.
The treatment of our patient had been sequential with: 5 weeks of quadritherapy (Isoniazid 50mg*4/day + Rifampicin 120mg*4/day + Pyrazinamide 300mg*4/day + Ethambutol 500 mg/day); then 5 weeks of tritherapy (same doses without ethambutol - stopped because we suspected a peripheral neuropathy); and lastly 4 months of bitherapy (Isoniazid 50mg*2/day + Rifampicin 120mg*2/day).
After 3 months of treatment, we noted a normalization of the gynecologic examination with regression of the vaginal mass. In the same time, a new scanner has been done to control the lung lesion: we found a progression of the right lobar mass. Biopsy revealed an adenocarcinoma, treated by surgery - radiotherapy and chemotherapy.