Vaginal oligometastatic disease of colorectal primary is a rare malignancy with few reported cases in the literature and no standardized treatment paradigm. We report on the definitive management of an unusual case of an elderly woman with the aforementioned disease. A 78-year-old African-American woman presented with vaginal spotting and was found to have a vaginal lesion. Final pathology was consistent with moderately differentiated adenocarcinoma of colorectal primary. Extensive work up, which included endoscopies, pathologic analyzes, and imaging workup, did not reveal a primary gastrointestinal malignancy. The patient underwent partial vaginectomy and final pathology once again confirmed moderately differentiated adenocarcinoma of colorectal primary (CDX 2 and CEA positive, ER/PR, and CK 7 negative) with negative margins. She went on to receive adjuvant concurrent chemoradiation with 5-FU based chemotherapy. She received 45 Gy in 25 fractions to the whole pelvis followed by an HDR brachytherapy boost to 12 Gy in two fractions. Unfortunately, 10 months after completing radiation, she was found to have adenocarcinoma arising from a hepatic flexure colon polyp on colonoscopy. She required definitive surgical resection and was staged as mpT3N0M1. She received 12 cycles of 5-FU and at 2-year follow-up was found to be disease free with no evidence of locoregional recurrence or distant metastatic disease. Continued long-term follow up is warranted.

1. Frank, SJ, Jhingran, A, Levenback, C, et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 2005; 62(1): 138–147.
Google Scholar | Crossref | Medline2. Hellman, S, Weichselbaum, RR. Oligometastases. J Clin Oncol 1995; 13(1): 8–10.
Google Scholar | Crossref | Medline | ISI3. Oonk, MHM, Slomovitz, B, Baldwin, PJW, et al. Radiotherapy versus inguinofemoral lymphadenectomy as treatment for vulvar cancer patients with micrometastases in the sentinel node: results of GROINSS-V II. J Clin Oncol Epub ahead of print 25 August 2021. JCO2100006. DOI: 10.1200/JCO.21.00006. PMID: 34432481.
Google Scholar4. Mazur, MT, Hsueh, S, Gersell, DJ. Metastases to the female genital tract. Analysis of 325 cases. Cancer 1984; 53(9): 1978–1984.
Google Scholar | Crossref | Medline5. Frank, SJ, Deavers, MT, Jhingran, A, et al. Primary adenocarcinoma of the vagina not associated with diethylstilbestrol (DES) exposure. Gynecol Oncol 2007; 105(2): 470–474.
Google Scholar | Crossref | Medline6. Sadatomo, A, Koinuma, K, Horie, H, et al. An isolated vaginal metastasis from rectal cancer. Ann Med Surg 2015; 5: 19–22.
Google Scholar | Crossref | Medline7. Bayrak, R, Haltas, H, Yenidunya, S. The value of CDX2 and cytokeratins 7 and 20 expression in differentiating colorectal adenocarcinomas from extraintestinal gastrointestinal adenocarcinomas: cytokeratin 7−/20+ phenotype is more specific than CDX2 antibody. Diagn Pathol 2012; 7(1): 9.
Google Scholar | Crossref | Medline8. Ramaekers, F, van Niekerk, C, Poels, L, et al. Use of monoclonal antibodies to keratin 7 in the differential diagnosis of adenocarcinomas. Am J Pathol 1990; 136(3): 641–655.
Google Scholar | Medline9. Sabbagh, C, Fuks, D, Regimbeau, J-M, et al. Isolated vaginal metastasis from rectal adenocarcinoma: a rare presentation. Colorectal Dis 2011; 13(10): e355–e356.
Google Scholar | Crossref | Medline10. Viswanathan, AN, Thomadsen, B; American Brachytherapy Society Cervical Cancer Recommendations Committee. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: general principles. Brachytherapy 2012; 11(1): 33–46.
Google Scholar | Crossref | Medline | ISI11. Beriwal, S, Demanes, DJ, Erickson, B, et al. American Brachytherapy Society consensus guidelines for interstitial brachytherapy for vaginal cancer. Brachytherapy 2012; 11(1): 68–75.
Google Scholar | Crossref | Medline