Vaginal metastasis presenting as postmenopausal bleeding

Abstract

Vaginal cancer is rare worldwide and represents 2% of all gynaecological cancers in Singapore. Primary vaginal malignancies are rare and vaginal metastases constitute the majority of vaginal malignancies. Most of these metastases arise from the cervix, endometrium or ovary, although they can also metastasise from distant sites such as the colon, breast and pancreas. We report a rare case of vaginal metastasis in a patient with previous gastric and rectal adenocarcinomas. An 89-year-old woman with a history of gastric and rectal malignancy presented with postmenopausal bleeding. A 2-cm vaginal tumour at the introitus was discovered upon examination. This case demonstrates the importance of performing a gynaecological examination during follow-up for patients with a history of malignancy. The prognosis for vaginal metastasis is poor, as it is often associated with disseminated disease. Depending on the extent of the lesions, radiotherapy or surgery can be considered.

Keywords: colon carcinoma; postmenopausal bleed; recurrence; vaginal metastasis.

Fig. 1

Photograph shows a vaginal tumour at the introitus.

Fig. 2

Photograph shows an atrophic cervix.

Fig. 3

Photomicrograph shows invasive glands with goblet cells (Haematoxylin & eosin, × 100).

Fig. 4

Photomicrograph shows closely packed cells with scattered goblet cells (Haematoxylin & eosin, × 400).

Fig. 5

CT image of the abdomen and pelvis shows a soft tissue density involving the lower-third of the vagina.

Fig. 6

MR images of the pelvis in (a) sagittal; (b) axial; and (c) coronal views show an approximately 2.6 cm × 1.4 cm lobulated mass (arrows) involving the lower-third of the vagina at the region of the introitus. There is involvement of the posterior and lateral vaginal walls with thickening of the anterior vaginal wall.