Vaginal Metastasis as Initial Manifestation of Renal Cell Carcinoma

Abstract

Metastasis from renal cell carcinoma to the vagina is rare, occurring mainly in post-menopausal women. The main prognostic factor is whether the metastasis is single or multiple. Few cases have been reported in the international literature, and the majority involves metastases from the left kidney. The authors present a case of renal cell carcinoma with metastasis to the vagina in a 53-year-old patient whose initial clinical presentation was a pedunculated mass with irregular edges on the posterior vaginal wall. The lesion was removed surgically and proved to be clear cell adenocarcinoma. Abdominal ultrasound showed an incidental mass in the left kidney, and left nephrectomy was performed. Immunohistochemical investigation proved the latter to be a primary renal cell carcinoma, with vaginal metastasis. The patient then received adjuvant radiotherapy to the vagina and pelvis. Eight months after initial treatment the patient received immunotherapy with interferon 2-alpha due to the appearance of a liver metastasis. Patient was alive 17 months after surgery.