Background: Vaginal metastasis from organs other than the uterus is rare. Generally, patients with vaginal metastasis from colorectal cancer have a dismal prognosis. Although biopsy is the best method to make the diagnosis, massive bleeding may occur. On the other hand, liquid-based cytology (LBC) has the utility to perform immunocytochemistry on additional unstained slides: we can make a diagnosis with several immunocytochemical findings. Case: A 67-year-old postmenopausal female presented to our hospital with vaginal bleeding. The patient had undergone colectomy because of her stage III sigmoid colon cancer 3 years earlier. The patient had also undergone hysterectomy for cervical cancer 30 years earlier. LBC from the vaginal stump revealed adenocarcinoma. Immunocytochemically, cancer cells were negative for cytokeratin 7 and positive for cytokeratin 20, which suggested metastasis from the sigmoid colon cancer; the diagnosis was made without a biopsy. Conclusion: When the patient has a metastatic lesion from colon adenocarcinoma, LBC with immunocytochemistry is useful in making a diagnosis.

Keywords:
Sigmoid colon cancer, Vaginal stump metastasis, Liquid-based cytology, Immunocytochemistry
1.
Shin JH, Bae JH, Lee A, Jung CK, Yim HW, Park JS, Lee KY: CK7, CK20, CDX2 and MUC2 immunohistochemical staining used to distinguish metastatic colorectal carcinoma involving ovary from primary ovarian mucinous adenocarcinoma. Jpn J Clin Oncol 2010;40:208–213.
2.
Porjazova E, Zaprjanov Z, Batashki I, Markova D, Milchev N: Immunohistochemical profile of colorectal and ovarian carcinomas – examination with cytokeratin 7, cytokeratin 20, beta catenin and cDX 2. Akush Ginekol 2009;48:7–12.
3.
Ikeda S, Fujimori M, Shibata S, Okajima M, Ishizaki Y, Kurihara T, Miyata Y, Iseki M, Shimizu Y, Tokumoto N, Ozaki S, Asahara T: Combined immunohistochemistry of beta-catenin, cytokeratin 7, and cytokeratin 20 is useful in discriminating primary lung adenocarcinomas from metastatic colorectal cancer. BMC Cancer 2006;6:31.
4.
Han CP, Kok LF, Lee MY, Wu TS, Ruan A, Cheng YW, Wang PH, Koo CL, Tyan YS: Five commonly used markers (p53, TTF1, CK7, CK20, and CK34betaE12) are of no use in distinguishing between primary endocervical and endometrial adenocarcinomas in a tissue microarray extension study. Arch Gynecol Obstet 2010;281:317–323.
5.
Vang R, Gown AM, Barry TS, Wheeler DT, Yemelyanova A, Seidman JD, Ronnett BM: Cytokeratins 7 and 20 in primary and secondary mucinous tumors of the ovary: analysis of coordinate immunohistochemical expression profiles and staining distribution in 179 cases. Am J Surg Pathol 2006;30:1130–1139.
6.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009. CA Cancer J Clin 2009;59:225–249.
7.
Dunn LJ, Napier JG: Primary carcinoma of the vagina. Am J Obstet Gynecol 1966;96:1112–1116.
8.
Way S: Vaginal metastases of carcinoma of the body of the uterus. J Obstet Gynaecol Br Emp 1951;58:558.
9.
Bergman F: Carcinoma of the ovary. A clinicopathological study of 86 autopsied cases with special reference to mode of spread. Acta Obstet Gynecol Scand 1966;45:211.
10.
Nerdrum TA: Vaginal metastasis of hypernephroma. Report of three cases. Acta Obstet Gynecol Scand 1966;45:515.
11.
Chagpar A, Kanthan SC: Vaginal metastasis of colon cancer. Am Surg 2001;67:171–172.
12.
Ng AB, Teeple D, Lindner EA, Reagan JW: The cellular manifestations of extrauterine cancer. Acta Cytol 1974;18:108–117.
13.
Guidozzi F, Sonnendecker EW, Wright C: Ovarian cancer with metastatic deposits in the cervix, vagina, or vulva preceding primary cytoreductive surgery. Gynecol Oncol 1993;49:225–228.
14.
Rubin BP, Skarin AT, Pisick E, Rizk M, Salgia R: Use of cytokeratins 7 and 20 in determining the origin of metastatic carcinoma of unknown primary, with special emphasis on lung cancer. Eur J Cancer Prev 2001;10:77–82.
15.
Rubin BP, Skarin AT, Pisick E, Rizk M, Salgia R: Use of cytokeratins 7 and 20 in determining the origin of metastatic carcinoma of unknown primary, with special emphasis on lung cancer. Eur J Cancer Prev 2001;10:77–82.
16.
Chu PG, Weiss LM: Keratin expression in human tissues and neoplasms. Histopathology 2002;40:403–439.
17.
Tot T: Cytokeratins 20 and 7 as biomarkers: usefulness in discriminating primary from metastatic adenocarcinoma. Eur J Cancer 2002;38:758–763.
18.
Chu P, Wu E, Weiss LM: Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: a survey of 435 cases. Mod Pathol 2000;13:962–972.
19.
Varadhachary GR, Abbruzzese JL, Lenzi R: Diagnostic strategies for unknown primary cancer. Cancer 2004;100:1776–1785.
20.
Li HX, Li M, Li CL, Ma JH, Wang MR, Rao J, Pan QJ: ImmunoCyt and cytokeratin 20 immunocytochemistry as adjunct markers for urine cytologic detection of bladder cancer: a prospective study. Anal Quant Cytol Histol 2010;32:45–52.
21.
Ghigna MR, Drak Alsibai K, Porras J, Palazzo L, Godchaux JM, Fabre M: Deep-seated rectal/anal basaloid carcinoma: useful immunocytochemistry in rare squamous cell carcinoma variants. Cytopathology 2009;20:315–320.
22.
Hashimoto K, Morimoto A, Kato M, Tominaga Y, Maeda N, Tsuzuki T, Yokoi T, Nagasaka T: Immunocytochemical analysis for differential diagnosis of thyroid lesions using liquid-based cytology. Nagoya J Med Sci 2011;73:15–24.
23.
Nishimura R, Aogi K, Yamamoto T, Takabatake D, Takashima S, Teramoto N, Kagawa A, Morita S: Usefulness of liquid-based cytology in hormone receptor analysis of breast cancer specimens. Virchows Arch 2011;458:153–158.
© 2012 S. Karger AG, Basel
2012
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