Search

We report a case of an advanced rectal cancer recurrence that responded completely to chemo-radiotherapy. The patient was an 80-year-old woman. Low anterior resection with D2(prxD3)lymph node dissection was performed. Sixteen months after operation, CEA level elevated but no recurrence foci were found in any image tests. Administration of TS-1 was initiated since recurrence was highly suspected. Twenty seven months after operation, PET-CT detected local recurrence in the posterior wall of the vagina. After construction colostomy, chemo-radiotherapy(60 Gy+oral UFT)was performed and CEA level dropped promptly to the normal value. No relapse was pointed out in CT scans or MRI tests. There were not any signs of recurrence through 112 months after chemo-radiotherapy.

The vaginal metastasis from colorectal cancer has rarely been reported. Here, we report a resected case of the vaginal metastasis from rectal cancer. A 51-year-old woman underwent radical hysterectomy and bilateral oophorectomy for uterus cancer. Five years after the operation, vaginal tumor was observed during an internal examination. Biopsy was positive for adenocarcinoma. Enhanced computed tomography demonstrated the wall thickening of the lower rectum and the mass of 20 mm at the inferior lobe of the left lung. Colonoscopy revealed the wall thickening of the lower rectum, and biopsy indicated a diagnosis of rectal cancer. We performed abdominoperineal resection and partial resection of the vagina. Pathological examination confirmed the vaginal metastasis from the rectal cancer.

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.

Vaginal metastasis is extremely rare, as is metastatic colorectal cancer. A 78-year-old woman was diagnosed with rectal cancer and uterine fibroid. Low anterior resection and simple hysterectomy was performed and the final diagnosis was fStage IIIa. Adjuvant chemotherapy was not performed. One year after the surgery, she was referred to our hospital with the chief complaint of hematuria. A tumor was observed in the posterior wall of the vagina. We performed vaginal mucosal resection and the pathological diagnosis was metastasis of rectal cancer. One year and 5 months after the surgery, we performed left inguinal node dissection and the pathological diagnosis was metastasis of rectal cancer. The patient has remained disease-free for 3 years and 5 months without adjuvant chemotherapy after resection of the vaginal metastasis.

A 55-year-old woman had urinary frequency and a constant urge to urinate. Computed tomography confirmed a urethral tumor, and transurethral biopsy confirmed adenocarcinoma. She visited our hospital to undergo treatment, and we performed an anterior pelvic excenteration. On histology, the tumor had spread to the bladder, urethra, and vagina. However, the majority of the tumor was located in the bladder and urethra, a duct with intestinal metaplasia was present around the urethra, and carcinoma in situ was seen in the urethral mucosa. Based on the above findings, the patient was diagnosed as having primary urethral adenocarcinoma. No tumor cells were seen in the resection stump. Six months after surgery, the patient developed bone metastasis, followed by peritoneal and pleural dissemination, as well as multiple lung metastases. The patient died nine months after surgery. In the present patient, the carbohydrate antigen (CA) 19-9 level changed with the clinical course, and it was a useful marker. Urethral tumor is relatively rare. A urethral tumor accompanied by vaginal wall infiltration is likely to be mistaken for a primary vaginal tumor. It was very difficult to identify the primary organ in our case. To the best of our knowledge, the present patient is the sixth reported case of primary urethral carcinoma accompanied by vaginal wall infiltration in Japan. The six reported cases are compared and analyzed.

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.

The majority of vaginal metastases from extra-genital tumors are from colorectal cancer. A case of metastases to the vagina from a huge rectal carcinoma is described. A 55-year-old woman was admitted to the hospital because of a barium ileus after upper GI. Further examination revealed that she had a huge rectal carcinoma. Hartmann's operation combined with resection of the right ureter, posterior wall of the uterus and left ovary was performed. Postoperative chemoradiotherapy was performed with 60 Gy of irradiation to the small pelvis with 500 mg/day continuous infusion of 5-FU. After 18 months, she had genital bleeding. Digital examination revealed a vaginal tumor and metastasis of the rectal carcinoma to the vagina was confirmed histologically. Abdominoperineal resection of the rectum and vagina combined with simple total hysterectomy and bilateral salpingo-oophorectomy was performed. Thirty-three months after operation, there is no sign of recurrence.

An 82-year-old female presented with asymptomatic gross hematuria in June 1997. Urethrocystoscopy revealed a multiple papillary tumor of the bladder and posterior urethra. Histology of the punch biopsy specimens of the tumor revealed transitional cell carcinoma (TCC), grade 2 (G2). CT scan showed no distant metastasis and extravesical invasion. The patient was treated by intravesical instillation of adriamycin (ADM), drip infusion of low dose cisplatin (CDDP) and irradiation of the bladder. As the treatment caused a significant tumor shrinkage, transurethral resection of the tumor was performed. Histologically, the tumor revealed no invasion to the muscular layer of the bladder. In April 1998 she noticed genital bleeding, and a multiple papillary tumor was found on the vaginal wall. Histology of punch biopsy specimens of the vaginal tumor showed non-invasive TCC, G2. MRI and specimens of all layer needle biopsy showed no infiltration outside the bladder wall and the vaginal wall. Irradiation of the cavity of the vagina and uterus was made under the diagnosis of superficial vaginal TCC. We assume that vaginal implantation via irrigating fluid or urine has occurred.

Cisplatin (CDDP) has been reported to be a most effective drug for gynecologic cancer. We investigated the efficacy of local injection of CDDP. The subjects are 3 patients with local recurrence of vaginal stump in a gynecologic malignant tumor. CDDP was injected locally in the tumor using a single dose of 10 mg for 5 days. The effects of the therapy were evaluated by cytology, tumor markers, ultrasonography and CT. The results of this therapy were PR in one patient and NC in two patients. One patient with ovarian carcinoma stage III c survived for 11 months following this therapy with CDDP. Her genital bleeding was stopped, and her performance status was improved. In conclusion, it is suggested that this therapy is useful for vaginal recurrence of a gynecologic malignant tumor. We hope that wider use of this method will improve the quality of life for end-stage patients.

Single vaginal administration of CDDP was done in a case of adenocarcinoma when relapse in the vaginal stump followed surgery for uterine corpus carcinoma. A tumor the size of a large fingertip in the vaginal stump was completely eliminated via 15-time (75 mg) CDDP vaginal administration, suggesting that this treatment was effective against adenocarcinoma. The only side effect over the whole body was slight pain developing in the external genitalia.