Montenegro John Fernando, Rivas Tafur Giovanna Patricia, Diaz Miguel, Alzate Diego Fernando, Faria María Camila, Florez Daniel, Acuña Richard Andrés, Eduardo Cesar, Liscano Yamil
Grupo de Investigación en Genética, Fisiología y Metabolismo (GEFIME), Ciencias de la Salud Universidad Santiago de Cali, Cali 760035, Colombia.
Programa de Especialización en Medicina Interna, Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia.
Diseases. 2025 Aug 8;13(8):251. doi: 10.3390/diseases13080251.
Colorectal cancer (CRC) most commonly metastasizes to the liver and lungs; however, synchronous metastases to pelvic structures such as the vagina and urethra are extremely rare, posing a significant diagnostic and therapeutic challenge. This report describes an unusual case of sigmoid colon adenocarcinoma with synchronous metastases to the vagina and urethra, highlighting its diagnostic evaluation and the value of a multidisciplinary approach. A 59-year-old woman with a history of deep vein thrombosis treated with apixaban presented with chronic constipation and pelvic bleeding. A gynecological evaluation revealed a vaginal lesion. A colonoscopy, biopsy, pelvic magnetic resonance imaging, and molecular profiling were performed. Treatment included chemotherapy (capecitabine and oxaliplatin), panitumumab, and pelvic radiotherapy. The biopsy confirmed a moderately differentiated invasive adenocarcinoma in the sigmoid colon with synchronous metastases to the vagina and urethra. Molecular profiling identified a and ), allowing for the use of targeted therapy. The patient achieved a complete response according to RECIST 1.1 criteria and significant symptomatic improvement, including pain reduction, although dosages were adjusted for thrombocytopenia. She is currently continuing palliative treatment with good tolerance and durable symptomatic improvement. This case underscores the need to consider unusual metastatic sites in patients with colorectal cancer presenting with gynecological symptoms. Early diagnosis, based on imaging and histology, alongside molecular characterization, is crucial for effective personalized therapy. Multidisciplinary coordination is key to optimizing clinical outcomes in these rare metastatic presentations.
结直肠癌（CRC）最常转移至肝脏和肺部；然而，同时转移至阴道和尿道等盆腔结构极为罕见，这带来了重大的诊断和治疗挑战。本报告描述了一例罕见的乙状结肠腺癌同时转移至阴道和尿道的病例，重点介绍了其诊断评估以及多学科方法的价值。一名59岁有阿哌沙班治疗深静脉血栓形成病史的女性，出现慢性便秘和盆腔出血。妇科检查发现阴道病变。进行了结肠镜检查、活检、盆腔磁共振成像和分子分析。治疗包括化疗（卡培他滨和奥沙利铂）、帕尼单抗和盆腔放疗。活检证实乙状结肠为中度分化浸润性腺癌，同时转移至阴道和尿道。分子分析确定了 以及），从而能够使用靶向治疗。根据RECIST 1.1标准，患者达到完全缓解，症状有显著改善，包括疼痛减轻，尽管因血小板减少症调整了剂量。她目前正在继续接受姑息治疗，耐受性良好，症状持续改善。该病例强调，对于出现妇科症状的结直肠癌患者，需要考虑不寻常的转移部位。基于影像学和组织学以及分子特征的早期诊断，对于有效的个性化治疗至关重要。多学科协作是优化这些罕见转移病例临床结局的关键。
