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Case Reports
. 2025 Feb 4;23(1):37.
doi: 10.1186/s12957-025-03684-7.

An unusual case of post-menopausal bleeding

Roli Purwar  1 , Jyothi Kanugonda  1 , Mridula Shukla  2 , Manoj Pandey  3
Affiliations
Case Reports

An unusual case of post-menopausal bleeding

Roli Purwar et al. World J Surg Oncol. .

Abstract

Background: Metastasis from Renal cell carcinoma at presentation is seen in nearly one fifth of the patients and commonly occur to lung, bone and liver. Synchronous vaginal and cervical metastasis is extremely rare. Several pathways have been proposed of which blood reflux from left renal vein to ovarian vein is most plausible. The prognosis is usually very poor as they are often associated with disseminated metastasis.

Case presentation: A 55-year-old women presented with post-menopausal vaginal bleeding, on examination a smooth mass occupying the vagina and obscuring the view of cervix with normal mucosa was found. Biopsy and Immunohistochemistry showed it to be renal cell carcinoma. Further investigations lead to identification of left renal mass with pulmonary, vaginal and cervical metastasis. Patient was started on Pazopanib 800 mg PO per day, and was lost to follow-up.

Conclusion: Vaginal metastasis presenting as post-menopausal bleeding is one of the rarest presentation of renal cell carcinoma with only 3 cases reported in literature before this. Metastatic tumors to the vagina are more common than primary tumors and are mostly from cervix, endometrium and ovary. A high index of suspicion and through examination and investigation is the key to correct diagnosis and management.

Keywords: Cervix; Kidney; Pazopanib; Renal cell carcinoma; Vaginal metastasis; Venous reflux.

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Conflict of interest statement

Declarations. Ethics and consent: Written informed consent was obtained from the patient for publication of case and accompanying images. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Per speculum examination showing mass occupying the vagina with normal looking stretched mucosa, the cervix is not visualized and presence of blood in the vagina
Fig. 2
Fig. 2
Computerized tomographic scan of the abdomen showing (A) Axial view of the Mass in the left kidney (B) Sagittal section showing mass in the left kidney with tumour thrombus in inferior vena cava
Fig. 3
Fig. 3
Magnetic resonance imaging of the pelvis showing (A) Mass occupying the vagina (B) Mass involving the cervix
Fig. 4
Fig. 4
Photomicrograph showing showed stratified squamous epithelium with acanthosis and regenerative atypia, and proliferating blood vessels, lined by plump endothelial cells (A) H &E 10 x (B) H&E 40x
Fig. 5
Fig. 5
Photomicrograph showing immunohistochemistry (A) CD10 magnification 40X (B) PAX 8 magnification 40X (C) Ki67 magnification 40x
See this image and copyright information in PMC

References

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    1. Pandey J, Syed W. Renal Cancer. StatPearls. Volume 6. Treasure Island (FL): StatPearls Publishing; 2022.
    1. Machiele R, Renbarger T, Guidry B. Severe vaginal bleeding in a case of renal cell carcinoma. Case Rep Obstet Gynecol. 2019;2019:2174051. 10.1155/2019/2174051. Published 2019 May 27. - PMC - PubMed
    1. Young JY, Han KS, Chung J, et al. Synchronous vaginal metastasis of renal cell carcinoma. Korean J Urol Oncol. 2007;5(2):102–4.

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