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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 169-170
 

Vaginal metastasis from renal cell carcinoma - a case report


Department of Urology and Transplantation, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad, India

Correspondence Address:
Pranjal Ramanlal Modi
A-161 Sarvodaya Nagar-1, Sola Road, Ghatlodia, Ahmedabad - 380 061
India
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Keywords: Vaginal metastasis, renal cell carcinoma.


How to cite this article:
Modi PR, John P J, Joshi DP, Joshi RN. Vaginal metastasis from renal cell carcinoma - a case report. Indian J Urol 2004;20:169-70

How to cite this URL:
Modi PR, John P J, Joshi DP, Joshi RN. Vaginal metastasis from renal cell carcinoma - a case report. Indian J Urol [serial online] 2004 [cited 2014 Oct 23];20:169-70. Available from: http://www.indianjurol.com/text.asp?2004/20/2/169/20749



   Case Report Top


A 40-year-old female was referred by a gynecologist for vaginal swelling and gross painless hematuria. Evalu­ation revealed a 4 cm broad based lesion near the introitus on the posterior vaginal wall and a palpable left renal mass [Figure - 1]. Abdominal computed tomography (CT) scan con­firmed a 9.4 cm solid left renal mass with tumor thrombus in the left renal vein [Figure - 2]. Metastatic survey did not reveal disseminated disease. Wedge biopsy of the vagi­nal mass revealed a clear cell carcinoma. The patient was treated by radical nephrectomy with wide excision of the vaginal metastasis. Microscopic examination of the kid­ney tumor revealed clear cell type renal cell carcinoma which was similar to the vaginal lesion. Patient had tumor­free survival at 20-months' follow-up.


   Comments Top


Approximately one-third of patients with renal cell car­cinoma have evidence of metastatic disease at presenta­tion. Renal cell carcinoma rarely metastasizes to the vagina. On a literature review it appears that about 81 cases of vaginal metastasis from renal cell carcinoma have been reported, of which 32 had isolated vaginal metastasis. [1] Vaginal lesions are usually detected earlier than the pri­mary tumor. Retrograde venous flow of tumor cells to the left ovarian vein and vaginal plexus explains the spread of left sided renal tumors to the vagina. Fine needle aspi­ration cytology may be helpful in diagnosing vaginal meta­stasis from renal cell carcinoma. [2] Histologically, metastatic clear cell carcinoma of the vagina is sometimes difficult to differentiate from primary mesonephric adenocarci­noma. Electron microscope study differentiates metastatic clear cell carcinoma of the vagina and primary mesone­phric adenocarcinoma; the former has brush border mi­crovilli and large lipid cytoplasmic bodies. [3] In the absence of any other metastatic lesion, treatment of both the pri­mary tumor as well as the isolated metastasis should be carried out with a surgical approach and consideration for curative radiotherapy. [1]

 
   References Top

1.Queiroz C, Bacchi CE, Oliveire C, Carvalho M, Santos DR. Cytologic diagnosis of vaginal metastasis from renal cell carcinoma - a case report. Acta Cytol 1999: 43: 1098-100.  Back to cited text no. 1    
2.Tannenbaum M. Ultrastructural pathology of human renal cell tumors. In: Sommer SC (ed.). Pathology Annual. Appleton Cen­tury Crofts, New York, 1971; vol 6: 249.  Back to cited text no. 2    
3.Tarraza HM, Meltzer SE, DeCain M, Jones MA. Vaginal metastases from renal cell carcinoma: report of four cases and review of the literature. Eur J Gynaecol Oncol 1998; 19: 14-8.  Back to cited text no. 3    


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  [Figure - 1], [Figure - 2]



 

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