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Secondary localization to vagina had a severe prognosis, suggesting a disseminated metatastic disease. We report the case of prevalent vaginal metastasis of adenocarcinoma of the transverse colon. A 65 years old patient has consulted for vaginal mass. After delayed diagnosis, she presented with disseminated metastatic disease with peritoneal carcinomatosis. After neoadjuvant chemotherapy, the following treatment consisted of complete cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and vaginal adjuvant radiotherapy. No recurrence occurred after one year. Vaginal metastasis of colon cancer are rare. The dark prognosis might justify a systematic gynecological examination of women presenting colorectal neoplasy.

Metastatic colorectal adenocarcinoma in the vagina is rare and there are few reported cases in the literature. This paper reports a case of a woman with an infiltrative mass in the vagina and a previous diagnosis of colorectal adenocarcinoma. The use of cervicovaginal liquid based cytology together with CK20 and CDX2 immunostaining allowed to confirm the neoplasia’s colorectal origin. This case enhanced the importance of the clinical history as well as the immunohistochemical staining in a diagnosis, since without them and just with the cellular characteristics observed the diagnosis could be of endocervical or endometrial adenocarcinoma., Citotech Online - Case Review, No. 2 (2016): Citotech Online - Case Review

Resumen Las metastasis vaginales de cancer de colon son raras. Lo mismo sucede con las metastasis uterinas. La coincidencia de ambas es excepcional. Despues de ser descartadas las causas mas frecuentes de sangrado genital, se ha de considerar el diagnostico de metastasis ante un sangrado anormal en una mujer con antecedente de cancer. Debido a la rareza de estos casos, no existen pautas de tratamiento establecidas ni datos de supervivencia. Lo que mas parece ensombrecer el pronostico es la presencia de una metastasis uterina que casi siempre esta asociada a enfermedad metastasica generalizada.

69-year-old woman underwent left nephroureterectomy for left ureteral cancer (urothelial carcinoma (UC), high grade, pT3pN0) in September 2013. She returned to our hospital presenting with asymptomatic macrohematuria in July 2014. Cystoscopy showed tiny papillary tumors in the bladder. We also found genital bleeding from multiple papillary tumors on the vaginal wall. We performed transurethral resection of the bladder tumor and a biopsy of the vaginal wall demonstrated non-invasive UC, high grade. Pelvic magnetic resonance imaging after the operation showed no infiltration outside the bladder wall and vaginal wall. Therefore, we performed endoscopic excision of the vaginal tumor. However we could not resect all vaginal tumors. Irradiation of the vagina and uterus was performed under the diagnosis of metastasis of UC tovagina. Vaginal UC is extremely rare and this is the 26th case report in the literature.

大腸癌における再発巣の部位では腟転移は非常に稀である．今回，我々は直腸癌（Ra）術後2年に腟転移を認めた症例を経験したので，再発経路など文献的考察をふまえて報告する．症例は77歳女性．2007年7月直腸癌に対し当科で直腸低位前方切除術+リンパ節郭清（D3）を行った．術後フッ化ピリミジン経口抗がん剤内服にて補助療法を行った．術後経過良好であったが，術後2年のフォローアップCTにて傍大動脈リンパ節の腫脹を認めた．次いでFDG-PET検査を行ったところ，同部位と外陰部に強い集積を認めた．外陰部異常所見に対し，産婦人科にて精査を行ったところ腟に粘膜病変を認め，生検でAdenocarcinomaと診断された．直腸癌術後腟転移，傍大動脈リンパ節転移再発と診断し，中心静脈カテーテルポートを用いた化学療法（mFOLFOX6）と腟転移巣の切除を行った．現在転移再発治療開始後1年7カ月経過しており治療を継続している．

Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of symptoms from a vaginal metastasis.Key words: Vagin, pancreatic cancer, metastases

We tried to evaluate the demographic characteristics, treatment modalities and survival chances of the choriocarcinoma cases diagnosed in our hospital retrospectively. Eleven patients diagnosed with choriocarcinoma and treated in our department between January 1994 and December 2001 were used in this study. Seven cases (63.6%) had pulmonary metastasis when diagnosed and one case (9.1%) had additional vaginal metastasis. First-line chemotherapy was given to nine patients (81.9%) and adjuvant chemotherapy was given to two (18.1%), after primary hysterectomy. Interval hysterectomy was applied after four cures of chemotherapy (Methotrexate 0.4 mg/kg 5 days) to two out of the nine cases who had first-line chemotherapy (18.1%). Two hundred and seventy-four (12.7%) of 2155 genital tumors followed-up in the SSK Aegean Maternity Hospital Oncology Department were gestational trophoblastic diseases (GTD). Eleven cases (18.6%) out of 59 (21.5%) who had been given chemotherapy because of differentiation from GTD to ge...

74歳女.主訴は不正性器出血であった.過去17年間に表在性膀胱癌の膀胱内再発を繰返し計4回のTUR-BTを施行され, 3年前には膀胱癌の再発を認め単純膀胱全摘術が施行された.今回, 内診で腟粘膜の数ヶ所にびらんと発赤を認め, 同部位の生検でTCCの病理学的診断を得て, 尿路上皮癌の腟転移と診断した.この時点で多臓器への転移再発を認めなかったので, 根治的に子宮腟尿道全摘術を施行した.病理組織学的には腟粘膜上3ヶ所にTCC(G3)が腟粘膜から浅筋層に浸潤する像を認めた.術後9ヵ月, 骨盤内再発・鼠径部リンパ節転移を認め, 化学療法を施行したが, 皮膚・骨転移をきたし死亡した.尿路上皮癌が腟粘膜に転移をきたした非常に稀な症例であった, A 74-year-old female with a complaint of genital bleeding was referred to our hospital. In her past history, 4 times of transurethral resection of bladder tumor (TUR-BT) for bladder cancers and right nephroureterectomy with cuff for right ureteral tumors were performed during these 17 years, followed by simple cystectomy 3 years before. A punch biopsy of anterior vaginal wall demonstrated metastases of transitional cell carcinoma. Although total histero-vaginectomy was performed, recurrence of disease was observed in bone, skin and inguinal lymph nodes 9 months after the operation. This case is the 13th report of vaginal metastases of transitional cell carcinoma in the world.

大腸癌では,血行性・リンパ行性の膣壁転移は極めてまれであり,これまでに詳細な報告例は,本邦ではわずか5例しかない.今回,我々は,膣壁転移を伴ったS状結腸癌の1切除例を経験した.症例は74歳,女性.不正性器出血を主訴に当院産婦人科を受診した.内診にて膣壁に2cm大の腫瘍が認められ,生検にて腺癌と診断された.大腸内視鏡にてS状結腸に1/2周性の2型進行癌が認められた.手術時,腹水や腹膜播種は認められなかった.S状結腸癌は漿膜面へは露出しておらず,膣とは接していなかった.S状結腸切除術の後,経膣的膣壁腫瘍切除術が施行された.S状結腸癌は径28mm,中分化腺癌,sslylvln(-)と診断された.膣壁腫瘍は径23mmで,S状結腸癌と極めて類似した癌病巣が平滑筋層と横紋筋層の間にまで浸潤していた.病理組織学的所見の詳細な検討より,膣壁腫瘍はS状結腸癌からの脈管性転移と診断された.

► First case of cervical villoglandular cancer with concurrent vaginal skip metastasis. ► Rapid progression to advanced stage with good response to adjuvant therapy.

A patient presenting with antepartum haemorrhage due to a vaginal metastasis of choriocarcinoma is reported. Following delivery she was successfully treated with chemotherapy and surgery. This report details this unusual presentation and reviews the literature on this rare condition.

Alveolar soft part sarcoma (ASPS) of the vagina is an exceptionally rare neoplasm. Furthermore, vaginal metastasis of ASPS has not been reported. A 28-year-old woman with a history of a right thigh mass diagnosed as ASPS excised 8 years ago presented to the emergency room with massive vaginal bleeding and anemia. Biopsy of a vaginal mass revealed that the tumor was a vaginal metastasis of ASPS. For control of intractable bleeding and preventing further transfusions, palliative radiation therapy was planned. She received a total of 39 Gy (daily 3 Gy, using 15-MV photons), and after 6-Gy irradiation, there was no more vaginal bleeding and no more transfusion needed. This is the first case of vaginal metastasis of ASPS reported in the literature that was manifested by intractable vaginal bleeding, which was controlled successfully with radiation therapy.

Choriocarcinoma is a highly malignant tumour that arrise from trophoblastic tissue. It metastsize rapidly to vital organs including lungs and brain. It shows very good response to appropriately chosen chemotherapeutic regimen. A case of gestational choriocarcinoma with vaginal metastasis is reported. She responded very well to EMACO regime. Considering poor compliance for long term follow up, hysterectomy was done after 3 cycles of chemotherapy. She was disease free during three years of follow up.

A 35-year-old female presented with pain and swelling of the distal left radius. A diagnosis of Ewing sarcoma was made and she underwent neoadjuvant chemotherapy and surgery. Macroscopic viable areas remained on the map of the surgical specimen; as such, she was classified as a poor responder and received high dose adjuvant chemotherapy. She remained disease-free for five years, until age 40. A vaginal polyp was then detected during a routine gynaecologic examination. It was removed and histopathology revealed metastatic Ewing sarcoma. To our knowledge, this is the first reported case of a vaginal metastasis of Ewing sarcoma.

Metastasis from renal cell carcinoma to the vagina is rare, occurring mainly in post-menopausal women. The main prognostic factor is whether the metastasis is single or multiple. Few cases have been reported in the international literature, and the majority involves metastases from the left kidney. The authors present a case of renal cell carcinoma with metastasis to the vagina in a 53-year-old patient whose initial clinical presentation was a pedunculated mass with irregular edges on the posterior vaginal wall. The lesion was removed surgically and proved to be clear cell adenocarcinoma. Abdominal ultrasound showed an incidental mass in the left kidney, and left nephrectomy was performed. Immunohistochemical investigation proved the latter to be a primary renal cell carcinoma, with vaginal metastasis. The patient then received adjuvant radiotherapy to the vagina and pelvis. Eight months after initial treatment the patient received immunotherapy with interferon 2-alpha due to the appearance of a liver metastasis. Patient was alive 17 months after surgery. A ocorrência de metástases de carcinoma de células renais para a vagina é rara. Ocorre principalmente em mulheres na pós-menopausa e o principal fator prognóstico é se essa metástase apresenta-se ou não isolada. Poucos casos foram relatados na literatura mundial e a maioria destes envolve metástases originadas no rim esquerdo. Os autores apresentam um caso de metástase vaginal de carcinoma de células renais em uma paciente de 53 anos de idade cuja apresentação clínica inicial foi de uma massa pediculada com bordas irregulares na parede posterior da vagina. Realizou-se a retirada cirúrgica da lesão que revelou tratar-se de adenocarcinoma de células claras. A ultrasonografia abdominal evidenciou presença de massa incidental no rim esquerdo e foi realizada a nefrectomia deste rim. O estudo imunoistoquímico realizado demonstrou tratar de lesão neoplásica primária do rim com metástase para a vagina. A paciente, então, recebeu radioterapia adjuvante na vagina e na pelve. Após oito meses do início do tratamento, realizou-se imunoterapia com interferon 2 devido ao aparecimento de metástase também para o fígado. A paciente encontra-se viva 17 meses após a cirurgia. &nbsp

A 74-year-old female with a complaint of genital bleeding was referred to our hospital. In her past history, 4 times of transurethral resection of bladder tumor (TUR-BT) for bladder cancers and right nephroureterectomy with cuff for right ureteral tumors were performed during these 17 years, followed by simple cystectomy 3 years before. A punch biopsy of anterior vaginal wall demonstrated metastases of transitional cell carcinoma. Although total histero-vaginectomy was performed, recurrence of disease was observed in bone, skin and inguinal lymph nodes 9 months after the operation. This case is the 13th report of vaginal metastases of transitional cell carcinoma in the world.

A 53-year-old woman was referred urgently to the urology department with a history of worsening right renal angle pain and associated hematuria. Further investigations revealed the presence of a primary non-small cell lung cancer (NSCLC) invading the posterior chest wall with an associated vaginal metastasis. To our knowledge, this is only the second case report in the literature of a vaginal metastasis from NSCLC.

A case of renal clear cell carcinoma in which metastasis to vagina occurred before the primary diagnosis of tumor was established is reported and a summary of the literature is given.

Forty-one cases of adenocarcinoma of the female urethra reported in the literature with adequate clinical and pathological data are reviewed. Three additional cases are reported. Two patients died shortly after initial treatment, one with widespread metastases. The third patient survives without clinical evidence of tumor 4 years after initial surgical therapy and one year after radiation treatment of a vaginal metastasis.

A case of vaginal carcinoma, metastatic from a hypernephroma is presented. Diagnosis of hypernephroma was first made through microscopic examination of the vaginal tumor.

Vaginal metastasis from a renal cell carcinoma appeared 23 years after the primary surgery in a 64-year-old female. At angiographic work-up local recurrence in the renal fossa and liver metastasis were demonstrated. These findings indicated radiation treatment instead of radical surgery of the vaginal metastasis, which primarily was thought to be solitary. Angiography and/or computorized tomography (CT) of the retroperitoneal space and the liver should be performed in patients with late and presumed solitary metastasis from a renal cell carcinoma before radical surgery of the metastasis is attempted.

Four cases of solitary vaginal metastasis from previously unsuspected renal cell carcinoma are presented. Vaginal bleeding, the presenting symptom in each patient, led to the finding of the metastatic vaginal lesion and to the urological evaluation, which revealed the occult primary renal cell carcinoma. With surgical treatment 2 of the 4 patients have remained well for more than 5 years.

SUMMARY In this paper, a new case of vaginal metastasis from a hypernephroma is described. Of interest is the appearance of the vaginal lesion, as well as pulmonary, bone and possible kidney and cerebral metastases 6 years following the resection of the original tumour. So far as we have been able to determine, 51 previous cases of hypernephroma with metastasis to the vagina have been recorded in the literature with the vaginal lesion appearing first in the majority of cases. Mention of primary vaginal mesonephric clear cell adenocarcinoma is made.