Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Isolated vaginal metastasis from stage I colon cancer: A case report
Soon Keun Kwon, Chang Sik Yu, Shin-Wha Lee, Jihun Kim, Inho Song, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim
Soon Keun Kwon, Chang Sik Yu, Inho Song, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Shin-Wha Lee, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Jihun Kim, Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Kwon SK reviewed the medical records, searched and summarized the previous literatures, and wrote the manuscript; Yu CS designed this case report, reviewed and edited manuscript as written by Kwon SK; Lee SW performed gynecologic management and surveillance; Kim JC reviewed the pathologic slides and confirmed the pathologic diagnosis; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chang Sik Yu, MD, PhD, Doctor, Professor, Surgeon, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Received: December 9, 2019
Peer-review started: December 9, 2019
First decision: December 30, 2019
Revised: January 12, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 6, 2020
BACKGROUND
Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer (CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis (VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer (T2N0) and herein present the case of this patient.
CASE SUMMARY
A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I (T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient. Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.
CONCLUSION
VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.
Core tip: Vaginal metastasis (VM) from colorectal cancer is rare. To our knowledge, this is the first case of VM from stage I colorectal cancer to be reported in English. Although the prognosis of VM is considered dismal, it seems to be favorable when it occurs isolated, without other metastases. The standard treatment has not yet been established because of rarity. The treatment needs to be established individually, and multidisciplinary teams can be helpful. Most patients with VM complain about gynecologic symptoms such as vaginal bleeding, so it should not be overlooked even in patient with stage I colorectal cancer.
