Renal cell carcinoma (RCC) rarely metastasizes to the vagina, with approximately 80 cases reported, and no established treatment guidelines exist for management. We report a case of a 57-year-old woman with heavily pretreated, metastatic clear cell RCC who developed a symptomatic vaginal metastasis refractory to multiple systemic therapies and palliative radiation. She achieved complete clinical remission and significant radiographic regression following a novel combination of belzutifan (hypoxia-inducible factor 2 alpha inhibitor) and transarterial embolization, both well tolerated. This is the first documented case of this combined approach for RCC vaginal metastasis, suggesting a promising therapeutic strategy for managing rare, refractory metastatic sites.

Osimertinib with chemotherapy in advanced non-small cell lung cancer with vaginal metastasis harboring EGFR exon 21 L858R and NTRK1 exon 16 V679M mutations: a case report with prolonged progression-free survival

A Case of Vaginal Metastasis Following Surgery for Cecal Cancer

High-grade endometrial stromal sarcoma with bilateral renal and vaginal metastasis: A case report

IntroductionPrimary vulvar cancer is uncommon, accounting for only 3%–5% of all gynecological malignancies. Metastases to the vulva are even rarer, and those originating from breast cancer are exceptional, with fewer than 20 cases reported in the literature.Case PresentationWe report the first case observed at our institution. A 38‐year‐old woman had been treated for breast cancer. Ten years after completing treatment, she presented with an analgesic‐resistant headache, cervical swelling, and vulvar discomfort. Updated staging revealed hepatic, pulmonary, pleural, and bone metastases. Biopsy of the vulvar lesion confirmed metastasis of an infiltrating ductal breast carcinoma. The patient underwent chemotherapy, with disease progression despite treatment. She is currently receiving palliative chemotherapy.ConclusionEarly detection of unusual metastatic sites and appropriate management require careful monitoring of women with breast cancer. Pelvic and gynecological examinations should be included in the follow‐up of breast cancer patients to detect vulvar or vaginal metastases.

Vaginal metastasis in gestational trophoblastic neoplasia: Experience from Sheffield trophoblastic disease Centre and recommendations for management

Consensus Guidelines for Delineation of Clinical Target Volumes for Intensity Modulated Radiation Therapy for Intact Cervical Cancer: An Update

Isolated vaginal metastasis from colorectal cancer is a rare entity with very few reports in the literature. Here we report a patient who presented with bleeding per vagina from a vaginal mucosal lesion. Biopsy of the vaginal lesion indicated a metastatic adenocarcinoma from a colorectal primary. Further workup of the patient with colonoscopy and Positron emission tomography (PET CT) indicated a primary in the sigmoid colon. As the patient had a single site of metastasis, she was planned for definitive management. The colonic primary, as well as the vaginal deposit were managed surgically. Further, the patient received adjuvant chemotherapy as well as adjuvant external beam radiation to the site of the vaginal lesion. Vaginal metastases from colorectal primary are usually part of systemic dissemination with multiple metastatic sites and hence has poor prognosis. When the patient presents with an isolated metastasis in the vagina., the survival appears reasonable as per the few reports available in the literature. Due to the rarity of the presentation, there are no standard treatment guidelines available. Surgical management, radiation and adjuvant chemotherapy have been used in varying combinations in the reports available in the literature. To conclude, vaginal metastasis should be included in the differential diagnosis of patients presenting with vaginal bleeding, especially with a history of colorectal carcinoma. Available limited evidence suggests that isolated vaginal metastasis from colorectal cancer that is amenable to local surgical resection has a reasonable outcome. Hence, isolated vaginal metastasis should be treated with curative intent in a multidisciplinary context like other sites of oligometastatic disease.

Abstract Background: Chemotherapy-induced oral mucositis (OM) is a common complication of cancer chemotherapy and is usually accompanied by severe pain. Studies indicate that about half of the patients undergoing standard chemotherapy and more than two-thirds of those undergoing high-dose chemotherapy will develop mucositis. The management has been challenging due to scarce evidence-based protocol. Case Reports: We present two cases of OM following chemotherapy at Obafemi Awolowo Teaching Hospitals. Case 1 is a 34-year-old woman receiving chemotherapy for choriocarcinoma with vaginal metastases who developed severe OM (WHO Grade 4) at the 5th cycle. Case 2 is a 72-year-old male being treated for bone marrow lymphoma. He developed severe OM (WHO Grade 4) with protracted healing. Preventive measures were instituted for the next cycle of chemotherapy. Both patients had oral candidiasis. Intensive oral care with the management of symptoms was instituted in treating both patients. Conclusion: Symptoms management and instituting preventive measures remain the mainstay of management of OM.

Functional characterization of PI3K C2 domain mutations detected in breast cancer circulating tumor cells and metastatic cells

Vaginal Metastasis from Breast Cancer: A Case Report and Review of the Literature

Introduction. Colorectal cancer, including cancer of the transverse colon, is known for its potential to metastasize to distant organs. Although the liver and lungs are common metastatic sites, metastasis to the vagina is rare and poses unique challenges for treatment. Methods. This case report details a rare instance of vaginal metastasis in a 58-year-old patient with advanced transverse colon adenocarcinoma. According to our experience, intracavitary brachytherapy of metastasis into the vagina is not effective, especially in cases of volumetric tumors. Results. As a rule, we use interstitial brachytherapy with an intracavitary applicator of maximal diameter. Over a 24-month follow-up period, there was no local recurrence or progression of the disease, along with improved quality of life for the patient. Conclusions. This case highlights the importance of personalized treatment approaches and underscores the need for further research to optimize brachytherapy protocols for the effective treatment of rare metastatic sites in colorectal cancer.

ObjectiveTo develop a novel machine learning-based preoperative prediction model for pelvic lymph node metastasis (PLNM) in early-stage cervical cancer by combining the clinical findings and preoperative computerized tomography (CT) of the whole abdomen and pelvis.MethodsPatients diagnosed with International Federation of Gynecology and Obstetrics stage IA2-IIA1 squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix who had primary radical surgery with bilateral pelvic lymphadenectomy from January 1, 2003 to December 31, 2020, were included. Seven supervised machine learning algorithms, including logistic regression, random forest, support vector machine, adaptive boosting, gradient boosting, extreme gradient boosting, and category boosting, were used to evaluate the risk of PLNM.ResultsPLNM was found in 199 (23.9%) of 832 patients included. Younger age, larger tumor size, higher stage, no prior conization, tumor appearance, adenosquamous histology, and vaginal metastasis as well as the CT findings of larger tumor size, parametrial metastasis, pelvic lymph node enlargement, and vaginal metastasis, were significantly associated with PLNM. The models’ predictive performance, including accuracy (89.1%–90.6%), area under the receiver operating characteristics curve (86.9%–91.0%), sensitivity (77.4%–82.4%), specificity (92.1%–94.3%), positive predictive value (77.0%–81.7%), and negative predictive value (93.0%–94.4%), appeared satisfactory and comparable among all the algorithms. After optimizing the model’s decision threshold to enhance the sensitivity to at least 95%, the ‘highly sensitive’ model was obtained with a 2.5%–4.4% false-negative rate of PLNM prediction.ConclusionWe developed prediction models for PLNM in early-stage cervical cancer with promising prediction performance in our setting. Further external validation in other populations is needed with potential clinical applications.

Aim: Primary vaginal cancer is rare, comprising about 3% of all gynaecological malignancies. Solitary bone metastases to appendicular skeleton are extremely rare and there are only few published reports. We report the case of isolated metastasis in the tibia as a feature of primary squamous vaginal carcinoma. We present this case because of its rarity and for documentation and discussion purposes. Case report: We present a case of a 44-year old woman diagnosed with squamos vaginal cancer in June 2015. Computed tomography of the thorax, abdomen and pelvis revealed no distant metastases. She was treated with interstitial intracavitary brachytherapy and concomitant chemoradiotherapy. In March 2016 she was admitted to our hospital because of the swelling and the pain in the lower right leg. There was no history of trauma and plain radiographs were normal. Two months later, after further progression of pain, plain radiographs showed intramedullary permeative bone lesion with cortical disruption of tibial dyaphisis and local soft tissue swelling. MRI and core needle biopsy confirmed vaginal cancer metastasis containing tumor cells identical to the primary tumor. The patient was treated with radiotherapy and chemotherapy. Despite the treatment there was further progression of the disease with multiple bone metastases and eventually lung and brain metastases. Conclusion: This case report is another reminder that although extremely rare, solitary metastatic bone lesions of vaginal cancer are possible. Since symptoms mimic various benign conditions, it is important to consider bone metastasis as possible diagnosis in patients with progressive bone pain not responding to analgesic treatment.

We present the case of a 71-year-old patient, with vaginal bleeding, dyspnea, headache, loss of appetite and weakness. Clinical examination revealed a pediculated vaginal mass of 25 mm diameter, of dark-red color and soft spongy consistency, with an ulcerated surface and originating from the anterior wall, which was surgically removed. The morphology was dominanted by large, round to polygonal tumor cells, arranged in a predominantly tubulo-cystic architecture, surrounding numerous blood vessels that dominated the appearance, suggesting a perivascular epithelioid cell tumor (PEComa) or hemangioblastoma but the presence of pleomorphic nuclei, numerous mitoses together with immunohistochemistry helped for a correct diagnosis of vaginal .

Objective:The aim was to evaluate vaginal brachytherapy (VB) after surgery in early-stage endometrial cancer.Materials and Methods:The patients with Stage I-II endometrial adeno-cancer operated between 1998 and 2018 and whose adjuvant therapies had been arranged were evaluated retrospectively.Results:A total of 618 patients were enrolled. In 409 patients in the low-risk group, the vaginal, pelvic recurrence, and distant metastasis rates were found to be higher in the VB group. When the results of 112 patients in the intermediate-risk group were evaluated, there was no statistically significant difference between the vaginal, pelvic recurrence, and distance metastasis rates. In 89 patients in the intermediate-high risk group, vaginal recurrence rates were 0%, 4.8%, 0%, and 25% for VB, external beam radiotherapy, combination radiotherapy, and the follow-up groups, respectively (p=0.010), and pelvic recurrence rates were found to be 18.2%, 0%, 1.9% and 0% (p=0.036). Distant metastasis rates were 0%, 0%, 9.6% and 0% (p=0.229). When the overall survival in all groups was examined, no significant difference was found between the groups.Conclusion:In conclusion, no adjuvant treatment is a proper approach for low-risk patients. Brachytherapy can be considered a suitable option for the intermediate risk group. Combined treatments instead of VB in the high-intermediate risk group would be preferred in terms of local control.

Metastatic spread is the single most significant predictor of poor survival in breast cancer. Some of the most common metastatic sites are the bones, lungs, liver, brain, and peritoneal cavity. Clinically metastatic breast cancer to the gynecologic tract is usually asymptomatic and diagnosed as an incidental finding during a histologic examination of gynecologic specimens resected for other reasons. Cases of metastatic breast cancer to gynecologic organs diagnosed from August 1995 to January 2021 were retrieved from our institution's pathology databases, and their clinicopathologic features were reviewed. The most common site of metastasis was the ovary which was involved in about 79% (22 of 28 cases) of metastases to the gynecologic tract. Clinically, only 8 cases (36%) presented with ovarian mass detected in imaging studies and the rest of the cases were all incidental findings. Among ovarian metastasis, 59% of cases were invasive lobular carcinoma and 41% were invasive ductal carcinoma. In 5 cases, metastatic breast cancer was found in the endometrium, including 2 cases with endometrial metastasis only and 3 cases with multiple gynecologic organs involved. Metastatic breast cancer rarely involved the lower gynecologic tract, with only 7% vaginal metastasis and 4% found in the vulva. The absolute majority of metastatic breast cancer outside of the ovaries were lobular carcinoma (88%). Most of the metastatic breast carcinomas were positive for estrogen receptor on immunohistochemistry (27 of 28 cases, 96%). Her-2/neu immunostaining was positive in 4 cases only (14%). Metastatic breast cancer needs to be distinguished from gynecologic primary neoplasms and metastatic tumors from adjacent urinary and GI tracts. A careful review of the patient's history and adequate immunohistochemistry panel are helpful to render the diagnosis.

EP42.04: Advanced choriocarcinoma with vaginal and pleural metastasis

A Case of Vaginal Metastasis of Rectal Cancer Caused by Abnormal Vaginal Bleeding

Long-Term Outcome and Failure Patterns in Early-Stage Endometrial Cancer After Postoperative Adjuvant Radiotherapy: A Multi-Institutional Analysis Update Data