Diagnosis of recurrent rectal cancer deep into the vaginal wall by transvaginal endoscopic ultrasound-guided fine needle aspiration

Abstract

Local recurrent rectal cancer may present with extraluminal lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is good for diagnosis of such an extraluminal lesion. A 51-year-old Asian female was diagnosed with uT3N0M0 rectal adenocarcinoma 31 months ago. She had undergone chemotherapy, radiotherapy and abdominoperineal resection (APR). Eight months ago, colonoscopy and computed tomography (CT) were unremarkable. Carcinoembryonic antigen was 1.1 ng/ml. Pelvic examination revealed a 3 x 2 cm firm soft-tissue mass palpable through the left vaginal wall. EUS revealed a mass in the left lateral vaginal wall measuring up to 21 x 27 mm in cross section without invasion of adjacent pelvic structures. Transvaginal EUS-FNA was performed with a 22-gauge needle. Final cytology confirmed recurrent rectal adenocarcinoma. Subsequent surgery also confirmed a 2.3 cm grade II adenocarcinoma. The tumor focally extended to the inked margin. The uterus and ovary specimen were negative for disease. We herein report a successful role of transvaginal EUS-FNA for early detection of recurrent rectal cancer at the vaginal wall after abdominoperineal resection (APR).