Symptomatic vaginal bleeding in a postmenopausal woman revealing colon adenocarcinoma metastasizing exclusively to the vagina

Metachronic distal rectovaginal septum metastasis with prior laparoscopic anterior resection for proximal rectal carcinoma

Metastatic disease in the vagina of other origins such as rectal cancer is rare and only very few cases have been reported. A female patient developed an isolated metachronic metastasis located at the lower part of the rectovaginal septum, 8 months after curative resection for proximal rectal cancer. An excision of the tumour was performed with primary closure of the vaginal wall. Histopathological examination confirmed the solid tumour to be metastatic disease from rectal origin with free margins. A year later, the patient received a lobectomy of the left lower lobe, due to distant metastasis of rectal origin 2 years after primary surgery. The patient is currently 4 years postoperatively, alive and shows no sign on recurrent disease. This case illustrates that awareness and early recognition of this rare presentation can lead to adequate treatment plans.

Isolated vaginal metastasis from stage I colon cancer: A case report

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.

MRI findings of a remote and isolated vaginal metastasis revealing an adenocarcinoma of the mid-sigmoid colon

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.

Vaginal metastases from colorectal cancer

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.