A Case of Rectal Carcinoid Diagnosed by Vaginal Invasion

Abstract

We report a rare case of rectal carcinoid diagnosed by vaginal invasion. A 65-year-old woman was pointed out vaginal bleeding when she had a group examination for uterine cancer. Biopsy of the vaginal wall revealed carcinoid. Endoscopic examination of the vagina showed yellowish, bleeding surface with ulceration in the left posterior side of the vaginal fornix. Colonoscopy revealed yellowish submucosal tumors in the rectum ; one is located in the middle rectum, and the other in the lower rectum. Biopsy specimen of the two rectal lesions were compatible with carcinoid. Magnetic resonance imaging showed a mass, measuring 3 cm in diameter, was located between the left upper side of the vagina and rectum. Computed tomography and ultrasonography showed multiple liver metastases. The operative findings were classified into stage IV〔H3P0N (－) A2 (SE) 〕. Abdomino-perineal resection of rectum with hysterectomy, partial resection of vagina, bilateral oophorectomy, and hepatic arterial cannulation was performed. Histological examination of the resected specimen revealed subepithelial infiltration of rectal carcinoid. In the Japanese literature (1978.6～1998.6) there are no case reports other than ours in which vaginal bleeding was a clue to the diagnosis of rectal carcinoid.