PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：结直肠癌的阴道转移很少发生，通常与其他转移性病变有关。孤立的转移是非常罕见的，文献中只有少数案例记录。结肠直肠癌的阴道受累主要是由原发性肿瘤的直接连续扩散引起的。
方法：我们介绍了一名70岁的非洲妇女被诊断为直肠中部腺癌的病例。她接受了化疗,放射治疗,和随后的前切除术。两个月后,在左阴道壁的下三分之一处发现了孤立的直肠癌转移，活检证实。结肠镜检查排除了结直肠复发。胸腹部计算机断层扫描显示无远处转移。患者接受了腹部会阴切除术，去除阴道侧壁和后壁，具有游离的宏观边缘和明确的结肠造口术。最终的组织病理学分析证实了阴道中分化腺癌的诊断，测量5×4.5厘米。在尊重直肠粘膜的同时，直肠壁本质上被肿瘤侵入到固有肌层。切除边缘为阴性。患者术后1周出院，无并发症发生。辅助化疗，患者目前正在接受良好的治疗。
结论：结直肠癌的阴道转移极为罕见。在结直肠癌患者的随访期间，建议进行警惕的妇科检查。诊断可能具有挑战性，特别是如果转移灶很小且无症状，即使经过标准的放射检查。手术切除后化疗是早期孤立转移患者的有效选择。
方法：我们介绍了一名70岁的非洲妇女被诊断为直肠中部腺癌的病例。她接受了化疗,放射治疗,和随后的前切除术。两个月后,在左阴道壁的下三分之一处发现了孤立的直肠癌转移，活检证实。结肠镜检查排除了结直肠复发。胸腹部计算机断层扫描显示无远处转移。患者接受了腹部会阴切除术，去除阴道侧壁和后壁，具有游离的宏观边缘和明确的结肠造口术。最终的组织病理学分析证实了阴道中分化腺癌的诊断，测量5×4.5厘米。在尊重直肠粘膜的同时，直肠壁本质上被肿瘤侵入到固有肌层。切除边缘为阴性。患者术后1周出院，无并发症发生。辅助化疗，患者目前正在接受良好的治疗。
结论：结直肠癌的阴道转移极为罕见。在结直肠癌患者的随访期间，建议进行警惕的妇科检查。诊断可能具有挑战性，特别是如果转移灶很小且无症状，即使经过标准的放射检查。手术切除后化疗是早期孤立转移患者的有效选择。
