Isolated vaginal metastasis from rectal adenocarcinoma: a rare presentation

Sabbagh, Charles; Fuks, David; Régimbeau, Jean Marc; Degremont, R.; Jarry-Tossou, V.; Mauvais, F.

doi:10.1111/j.1463-1318.2011.02605.x

Cited by 11 publications

(3 citation statements)

References 5 publications

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“…Typically, cancer metastasizes to the vagina through one of three routes: the lymphatics, direct extension through the Pouch of Douglas, or pathways via the fallopian tubes. 9 In this patient, given her prior hysterectomy with bilateral salpingoophorectomy, lack of primary disease noted on initial workup, and node-negative disease noted at time of colorectal surgery, it is most likely that the method of spread was hematogenous rather than through direct invasion, via the fallopian tubes, or through the lymphatic system.…”

Section: Discussion/conclusionmentioning

confidence: 89%

Vaginal oligometastatic disease of colorectal primary: Report of a novel therapeutic approach

et al. 2021

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Vaginal oligometastatic disease of colorectal primary is a rare malignancy with few reported cases in the literature and no standardized treatment paradigm. We report on the definitive management of an unusual case of an elderly woman with the aforementioned disease. A 78-year-old African-American woman presented with vaginal spotting and was found to have a vaginal lesion. Final pathology was consistent with moderately differentiated adenocarcinoma of colorectal primary. Extensive work up, which included endoscopies, pathologic analyzes, and imaging workup, did not reveal a primary gastrointestinal malignancy. The patient underwent partial vaginectomy and final pathology once again confirmed moderately differentiated adenocarcinoma of colorectal primary (CDX 2 and CEA positive, ER/PR, and CK 7 negative) with negative margins. She went on to receive adjuvant concurrent chemoradiation with 5-FU based chemotherapy. She received 45 Gy in 25 fractions to the whole pelvis followed by an HDR brachytherapy boost to 12 Gy in two fractions. Unfortunately, 10 months after completing radiation, she was found to have adenocarcinoma arising from a hepatic flexure colon polyp on colonoscopy. She required definitive surgical resection and was staged as mpT3N0M1. She received 12 cycles of 5-FU and at 2-year follow-up was found to be disease free with no evidence of locoregional recurrence or distant metastatic disease. Continued long-term follow up is warranted.

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Section: Discussion/conclusionmentioning

confidence: 89%

Vaginal oligometastatic disease of colorectal primary: Report of a novel therapeutic approach

et al. 2021

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“…Vaginal bleeding is by far the most common primary symptom in patients presenting either postmenopausal or postcoital [ 8 ]. Alongside this symptom, pelvic pain and the sensation of an intra-cavity mass are also common symptoms [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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

Tweed

Dam

Sosef

et al. 2023

Journal of Surgical Case Reports

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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.

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“…Mechanisms leading to the formation of vaginal metastases are thought to involve the lymphovascular pathways, direct infiltration through the Pouch of Douglas, and pathways via the fallopian tubes [3] . In the present patient, the rectal tumor had extramural extension with lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

An isolated vaginal metastasis from rectal cancer

Sadatomo

Koinuma

Horie

et al. 2016

Annals of Medicine &Amp; Surgery

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IntroductionIsolated 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 caseWe 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.DiscussionMost 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.ConclusionWe 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.

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Isolated vaginal metastasis from rectal adenocarcinoma: a rare presentation

Cited by 11 publications

References 5 publications

Vaginal oligometastatic disease of colorectal primary: Report of a novel therapeutic approach

Vaginal oligometastatic disease of colorectal primary: Report of a novel therapeutic approach

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

An isolated vaginal metastasis from rectal cancer

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