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The most common primary tumour type is squamous cell carcinoma. Primary adenocarcinomas of the vagina are extremely rare and of various morphological types, many of which are broadly similar to those arising in the cervix. When faced with a probable primary vaginal adenocarcinoma, the pathologist faces a dilemma since the normal vagina does not contain glands, making the origin difficult to explain, and a metastasis should always be excluded. In this review, we discuss primary vaginal adenocarcinomas and provide practical points for the pathologist in typing and reporting these neoplasms and in excluding a metastasis. 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