Department of Surgical Oncology, Faculty of Medicine of Tunis, Salah Azaiez Institute, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia.
LMBA (LR03ES03), Sciences Faculty of Tunis, University Tunis el Manar, Tunis, Tunisia.
J Med Case Rep. 2024 May 2;18(1):233. doi: 10.1186/s13256-024-04501-7.
Vaginal metastasis from colorectal cancer is a rare occurrence, typically associated with other metastatic lesions. Isolated metastasis is exceedingly uncommon, with only a few cases documented in the literature. Vaginal involvement in colorectal cancer primarily results from direct contiguous spread from the primary tumor.
We present the case of a 70-year-old African woman diagnosed with adenocarcinoma of the middle rectum. She underwent chemotherapy, radiotherapy, and subsequent anterior resection. After 2 months, an isolated metastasis of rectal cancer was identified in the lower third of the left vaginal wall, confirmed by biopsy. Colonoscopy ruled out colorectal recurrence. Thoraco-abdominal computed tomography scan showed no distant metastases. The patient underwent abdominoperineal resection, removing the lateral and posterior vaginal wall with free macroscopic margins and a definitive colostomy. The final histopathological analysis confirmed the diagnosis of moderately differentiated adenocarcinoma of the vagina, measuring 5 × 4.5 cm. The rectal wall was extrinsically invaded by the tumor down to the muscularis propria while respecting the rectal mucosa. Resection margins were negative. The patient was discharged 1 week postoperation with no complications. Adjuvant chemotherapy was indicated, and the patient is currently tolerating the treatment well.
Vaginal metastases from colorectal cancer are extremely rare. A vigilant gynecological examination is recommended during the follow-up of colorectal cancer patients. Diagnosis can be challenging, especially if the metastatic lesion is small and asymptomatic, even after standard radiological examination. Surgical resection followed by chemotherapy is a valid option for patients with early isolated metastases.
阴道转移来自结直肠癌是一种罕见的情况，通常与其他转移病变有关。孤立性转移极为罕见，文献中仅有少数病例报道。结直肠癌阴道受累主要是由于原发肿瘤直接连续扩散所致。
我们介绍一位 70 岁的非洲女性，诊断为直肠中段腺癌。她接受了化疗、放疗和随后的前切除术。2 个月后，在左阴道壁下三分之一处发现孤立的直肠癌转移，经活检证实。结肠镜检查排除了结直肠癌复发。胸腹部计算机断层扫描显示无远处转移。患者接受了腹会阴切除术，切除了带有游离肉眼边缘的阴道侧壁和后侧，以及确定性结肠造口术。最终的组织病理学分析证实了阴道中分化腺癌的诊断，大小为 5×4.5cm。肿瘤从直肠壁外向固有肌层侵犯，同时保留直肠黏膜。切缘阴性。患者术后 1 周出院，无并发症。建议辅助化疗，患者目前耐受良好。
结直肠癌阴道转移极为罕见。在结直肠癌患者的随访中，建议进行警惕性的妇科检查。即使在标准影像学检查后，如果转移病变较小且无症状，诊断仍然具有挑战性。对于早期孤立性转移的患者，手术切除加化疗是一种有效的选择。
