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CASE REPORT |
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| Year : 2004 | Volume
: 20
| Issue : 2 | Page : 169-170 |
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Vaginal metastasis from renal cell carcinoma - a case report
Pranjal Ramanlal Modi, P Jacob John, Deepak Pravinbhai Joshi, Rohit Naranbhai Joshi
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
 Source of Support: None, Conflict of Interest: None  | Check |
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 |
 Case Report | |  |
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 | | |
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 | | |
| 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.  |
| 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. |
| 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. |
[Figure - 1], [Figure - 2]
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