STRAIGHT CANCER VULA METASTASES: CASE REPORT

Case Presentation: A 48-year-old patient with a previous history of rectal cancer for sixteen years treated with rectosigmoidectomy and adjuvant chemotherapy and radiotherapy. Twelve years later, abnormal uterine bleeding underwent subtotal hysterectomy. In the histological analysis moderately differentiated adenocarcinoma, the pattern being consistent with primary rectal neoplasia. Exposed to new cycle of chemotherapy. One year ago, NIC2 trachelectomy with a negative control sac fundus cytopathology for malignant cells. Genetic screening for Lynch syndrome with no criteria. The period after completion of chemotherapy with follow-up colonoscopy and tomographic investigation was uneventful and indicated no evidence of recurrence. Recently, she arrived at the Surgical Cancerology department with a vulval vestibular mass with recent vaginal extension, friable and with bleeding of approximately 5cm and irregular appearance. The rectovaginal examination had no noticeable changes and there were no palpable inguinal lymph nodes. The patient underwent a biopsy which concluded adenocarcinoma with foci of necrosis and was compatible with the primary tumor site. Discussion: Primary vulvar cancer is uncommon, accounting for only 3-5% of all gynecological cancers and <1% of all cancers in women. Metastatic tumors of the vulva are even more uncommon, accounting for only 5 to 8% of all vulvar cancers. When metastatic lesions are of extragenital origin, the gastrointestinal system is most commonly affected. Colorectal cancer is one of the most common types of cancer in western countries, with the most frequent sites of metastatic involvement being the liver and lungs. More rarely, the disease spreads to the brain or bones. On the other hand, genital tract involvement is an extremely rare event and, if it occurs, the ovaries are most often affected followed by vaginal involvement. Final considerations:There is no proposed standard diagnosis and therapeutic methods for colorectal metastatic vulvar carcinoma. Due to the rare frequency of this disease, it is difficult to conduct large-scale laboratory experiments and prospective controlled clinical studies to clarify this disease. However, biopsy of all suspected lesions is important and tumor metastasis should always be a differential diagnosis.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019