1
|
Zhu XD, Wang J, You QH, Jiang TA. An isolated vaginal metastasis from intestinal signet ring cell carcinoma: a case report and literature review. BMC Cancer 2020; 20:478. [PMID: 32460802 PMCID: PMC7251816 DOI: 10.1186/s12885-020-06950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Isolated vaginal metastases from intestinal signet ring cell carcinoma are extremely rare. There are no reported cases in the domestic or foreign literature. The characteristics of such cases of metastasis remain relatively unknown. As a life-threatening malignant tumor, it is very important to carry out a systemic tumor examination and transvaginal biopsy, even though clinical symptoms are not typical and there is no systemic tumor history. Case presentation We present a case of an isolated vaginal metastasis from intestinal cancer in a 45-year-old female patient. The patient experienced a small amount of irregular vaginal bleeding and difficulty urinating. She had no history of systemic cancer. An early physical examination and transvaginal ultrasound (TVS) showed marked thickening of the entire vaginal wall. Pelvic nuclear magnetic resonance imaging (MRI) and a colposcopic biopsy were used to diagnose her with chronic vaginitis. An analysis of the vaginal wall biopsy showed signet ring cell carcinoma. Colorectal colonoscopy revealed advanced interstitial signet ring cell carcinoma as the primary source of vaginal wall infiltration. We review previous case reports of vaginal metastases from colorectal cancer and discuss the symptoms, pathological type, and outcomes. Conclusions We hypothesize that vaginal wall thickening and stiffness accompanied by chronic inflammatory-like changes may be clinical features of a vaginal metastasis of signet ring cell carcinoma of the intestine. We also emphasize that it is very important to perform a systemic tumor examination in a timely manner when a patient has the abovementioned symptoms.
Collapse
Affiliation(s)
- Xiao Dan Zhu
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Wang
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qin Han You
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tian An Jiang
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
2
|
Kwon SK, Yu CS, Lee SW, Kim J, Song I, Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, Kim JC. Isolated vaginal metastasis from stage I colon cancer: A case report. World J Clin Cases 2020; 8:527-534. [PMID: 32110662 PMCID: PMC7031836 DOI: 10.12998/wjcc.v8.i3.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer (CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis (VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer (T2N0) and herein present the case of this patient.
CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I (T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient. Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.
CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.
Collapse
Affiliation(s)
- Soon Keun Kwon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jihun Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Inho Song
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| |
Collapse
|
3
|
Abstract
The relapses of rectal cancer are most frequently localized in the pelvis, liver, and pelvic and para-aortic lymph nodes and lungs, whereas the vagina is an unusual site. We present here a 60-year-old woman presenting with lower abdominal discomfort 23 months after radical resection of rectal adenocarcinoma. An isolated, solitary, hypermetabolic mass in the right part of the vagina was detected by F-FDG PET/CT. Ultimately, the vaginal neoplasm was proved to be adenocarcinoma of rectal origin based on its shared histologic features and compatible immunostaining profile.
Collapse
|
4
|
Isolated Metastases to Multiple Genital Organs: a Curious Case of Metachronous Spread of Carcinoma Colon. Indian J Surg Oncol 2019; 10:321-323. [DOI: 10.1007/s13193-018-0855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
|
5
|
Ng QJ, Namuduri RP, Yam KL, Lim-Tan SK. Vaginal metastasis presenting as postmenopausal bleeding. Singapore Med J 2016; 56:e134-6. [PMID: 26311914 DOI: 10.11622/smedj.2015127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vaginal cancer is rare worldwide and represents 2% of all gynaecological cancers in Singapore. Primary vaginal malignancies are rare and vaginal metastases constitute the majority of vaginal malignancies. Most of these metastases arise from the cervix, endometrium or ovary, although they can also metastasise from distant sites such as the colon, breast and pancreas. We report a rare case of vaginal metastasis in a patient with previous gastric and rectal adenocarcinomas. An 89-year-old woman with a history of gastric and rectal malignancy presented with postmenopausal bleeding. A 2-cm vaginal tumour at the introitus was discovered upon examination. This case demonstrates the importance of performing a gynaecological examination during follow-up for patients with a history of malignancy. The prognosis for vaginal metastasis is poor, as it is often associated with disseminated disease. Depending on the extent of the lesions, radiotherapy or surgery can be considered.
Collapse
Affiliation(s)
- Qiu Ju Ng
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Rama Padma Namuduri
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Kwai Lam Yam
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Soo Kim Lim-Tan
- Department of Women's Pathology and Cytology, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
6
|
Sadatomo A, Koinuma K, Horie H, Lefor AK, Sata N. An isolated vaginal metastasis from rectal cancer. Ann Med Surg (Lond) 2015; 5:19-22. [PMID: 26793313 PMCID: PMC4680629 DOI: 10.1016/j.amsu.2015.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/02/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Isolated vaginal metastases from colorectal cancer are extremely rare. There are only a few reported cases in the English literature, and the characteristics of such cases of metastasis remain relatively unknown. Presentation of case We present a case of isolated vaginal metastasis from rectal cancer in a 78-year-old female patient. The patient had no symptoms related to vaginal tumor. Magnetic resonance imaging (MRI) showed thickening of the middle rectum and a vaginal tumor. Biopsy from the vaginal tumor showed adenocarcinoma, similar to the rectal lesion. Low anterior resection with ileostomy, hystero-oophorectomy, and transvaginal tumor resection was performed. After nineteen months, computed tomography scan revealed multiple lung metastases and recurrent tumor in the pelvis. The patient refused chemotherapy and is alive three months after developing recurrent disease. Discussion Most cases of primary vaginal carcinoma are squamous cell carcinoma. Other histologic types such as adenocarcinoma are usually metastatic lesions. Primary lesions associated with metastatic vaginal adenocarcinoma are most often the uterus, and are very rarely from the colon or rectum. We review previous case reports of isolated vaginal metastases from colorectal cancer and discuss their symptoms, treatments, and outcomes. Conclusion We should keep the vagina within the field of view of pelvic MRI, which is one of the preoperative diagnostic tools for colorectal cancer. If female patients show gynecological symptoms, gynecological examination should be recommended. Isolated vaginal metastases are an indication for surgical resection, and adjuvant chemotherapy is also recommended. Isolated vaginal metastasis from colorectal cancer are extremely rare. Synchronous isolated vaginal metastasis from rectal cancer is reported. To evaluate gynecological symptoms of female patient is important. MRI study is useful to detect and diagnose vaginal lesion.
Collapse
Affiliation(s)
- Ai Sadatomo
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Koji Koinuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
7
|
Quaranta D, Delotte J, Bongain A, François E, Bereder JM, Bernard JL. [Vaginal metastasis revealing an adenocarcinoma of the transverse colon]. ACTA ACUST UNITED AC 2014; 42:622-5. [PMID: 25153435 DOI: 10.1016/j.gyobfe.2014.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/11/2014] [Indexed: 12/23/2022]
Abstract
Secondary localization to vagina had a severe prognosis, suggesting a disseminated metatastic disease. We report the case of prevalent vaginal metastasis of adenocarcinoma of the transverse colon. A 65 years old patient has consulted for vaginal mass. After delayed diagnosis, she presented with disseminated metastatic disease with peritoneal carcinomatosis. After neoadjuvant chemotherapy, the following treatment consisted of complete cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and vaginal adjuvant radiotherapy. No recurrence occurred after one year. Vaginal metastasis of colon cancer are rare. The dark prognosis might justify a systematic gynecological examination of women presenting colorectal neoplasy.
Collapse
Affiliation(s)
- D Quaranta
- Service de gynécologie, obstétrique, reproduction et de médecine fœtale, hôpital Archet II, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France.
| | - J Delotte
- Service de gynécologie, obstétrique, reproduction et de médecine fœtale, hôpital Archet II, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France
| | - A Bongain
- Service de gynécologie, obstétrique, reproduction et de médecine fœtale, hôpital Archet II, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France
| | - E François
- Service de cancérologie digestive, centre Antoine-Lacassagne, 33 avenue de Valombrose, 06189 Nice cedex 2, France; Service de chirurgie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J-M Bereder
- Service de chirurgie générale et cancérologie digestive, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 3, France
| | - J-L Bernard
- Service de chirurgie générale et cancérologie digestive, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 3, France
| |
Collapse
|
8
|
D'Arco F, Pizzuti LM, Romano F, Natella V, Laccetti E, Storto G, Maurea S, Mainenti PP. MRI findings of a remote and isolated vaginal metastasis revealing an adenocarcinoma of the mid-sigmoid colon. Pol J Radiol 2014; 79:33-5. [PMID: 24567770 PMCID: PMC3930582 DOI: 10.12659/pjr.890032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/12/2013] [Indexed: 12/30/2022] Open
Abstract
A remote vaginal metastasis from a colo-rectal carcinoma is extremely rare. Only few cases have been described in the literature. The radiological appearances of a vaginal metastasis from colon-rectal cancer have not been extensively investigated. We report the MRI findings with clinical and pathological correlations of a remote and isolated vaginal metastasis revealing a mid-sigmoid adenocarcinoma in a 67 years old woman.
Collapse
Affiliation(s)
- Felice D'Arco
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Laura Micol Pizzuti
- Institute of Biostructure and Bioimaging, Italian National Research Council, Naples, Italy
| | - Federica Romano
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Valentina Natella
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Ettore Laccetti
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | | | - Simone Maurea
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructure and Bioimaging, Italian National Research Council, Naples, Italy
| |
Collapse
|
9
|
Ng HJ, Aly EH. Vaginal metastases from colorectal cancer. Int J Surg 2013; 11:1048-55. [PMID: 24076094 DOI: 10.1016/j.ijsu.2013.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/14/2013] [Accepted: 09/13/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Vaginal metastases originating from colorectal carcinoma are very rare. Due to the limited number of reported cases, there is no proposed standard treatment and little is known about its management outcome. AIM The aim of this article is to review the available literature to establish the clinical presentation, trends in treatment and prognosis of vaginal metastases from colorectal malignancy. METHODS A literature search using keywords used for database search were 'colorectal carcinoma', 'colorectal cancer', 'colon cancer' and 'vaginal metastasis'. RESULTS Of the 30 articles identified, 37 reported cases, were accessible for full evaluation. Cases reported originates from various countries and majority presented with vaginal bleeding. Diagnosis was established after histological examination and treatment options consist of surgical resection, radiotherapy or chemotherapy that have been used individually or in combination. Association with disseminated metastatic disease indicates ominous prognosis as seen in 32.4% (n = 12) cases. CONCLUSION Vaginal metastasis of colorectal cancer should be included in the differential diagnosis of a vaginal swelling. There is no proposed standard treatment for vaginal metastases but surgical resection is an appropriate approach for local control when no disseminated metastatic disease is documented.
Collapse
Affiliation(s)
- Hwei Jene Ng
- University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | | |
Collapse
|
10
|
Sabbagh C, Fuks D, Regimbeau JM, Degremont R, Jarry-Tossou V, Mauvais F. Isolated vaginal metastasis from rectal adenocarcinoma: a rare presentation. Colorectal Dis 2011; 13:e355-6. [PMID: 21689298 DOI: 10.1111/j.1463-1318.2011.02605.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Beauvais Hospital, Avenue Leon Blum, Beauvais Cedex, France
| | | | | | | | | | | |
Collapse
|
11
|
Ceccaroni M, Paglia A, Ruffo G, Scioscia M, Bruni F, Pesci A, Minelli L. Symptomatic vaginal bleeding in a postmenopausal woman revealing colon adenocarcinoma metastasizing exclusively to the vagina. J Minim Invasive Gynecol 2011; 17:779-81. [PMID: 20955988 DOI: 10.1016/j.jmig.2010.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/31/2010] [Accepted: 05/28/2010] [Indexed: 01/02/2023]
Abstract
Vaginal carcinomas are rare entities, accounting for 2% of all malignant cancers of the female genital tract, and the vast majority are metastatic. Adenocarcinoma of the colon metastasizing to the vagina is extremely rare, only 5 cases have been reported. We present the case of a woman who experienced vaginal bleeding as an isolated symptom of vaginal metastasis of colorectal adenocarcinoma. Vaginal localization of metastasis from colorectal cancer significantly worsens the survival prognosis, and a standard treatment has not yet been proposed. Potential mechanisms of spread of colorectal cancer to the vagina and therapeutic approaches are discussed. In this case, treatment included surgery and chemotherapy.
Collapse
Affiliation(s)
- Marcello Ceccaroni
- Gynaecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | | | | | | | | | | | | |
Collapse
|
12
|
Chuang XE, Loh HL, Sim HG, Fong KL, Tan MH. Papillary renal cell carcinoma with metastatic laparoscopic port site and vaginal involvement: a case report. J Med Case Rep 2011; 5:131. [PMID: 21457556 PMCID: PMC3077337 DOI: 10.1186/1752-1947-5-131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/01/2011] [Indexed: 11/15/2022] Open
Abstract
Introduction Laparoscopic port-site metastasis is a rare but well recognized outcome following surgery in urological cancers, with its etiology not clearly understood. Additionally, vaginal metastasis in clear cell renal cell carcinoma is rare, and has not been previously reported in the setting of papillary renal cell carcinoma. Case presentation We present the case of a 71-year-old Chinese woman with metastatic type II papillary renal cell carcinoma with histologically verified vaginal involvement and a concurrent laparoscopic port-site metastasis. This was also associated with a unique constellation of widely disseminated metastatic sites, which include a local relapse, the peritoneum and the urethra. Conclusion Laparoscopic port-site metastases are associated with the presence of advanced cancer with multiple sites of metastasis. We hypothesize from the findings of our report and background data that this phenomenon is more likely to be related to tumor factors rather than operative factors. We also present what is, to the best of our knowledge, the first reported case in the literature of vaginal and urethral metastasis and the second reported case of laparoscopic port-site recurrence.
Collapse
Affiliation(s)
- Xue En Chuang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
| | | | | | | | | |
Collapse
|
13
|
Kimura Y, Goi T, Fujioka M, Hirono Y, Iida A, Katayama K, Yamaguchi A. A Case of Vaginal Metastasis of Rectal Cancer Post-Operation. ACTA ACUST UNITED AC 2011. [DOI: 10.3862/jcoloproctology.64.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
14
|
|