Vaginal cancer with multiple liver and pulmonary metastases that achieved long-term survival
A 68-year-old woman was presented with left lower abdominal pain. Her medical and family histories were unremarkable. Physical examination showed a hard mass of 4 cm diameter originating from the lower portion of the anterior vaginal wall. Biopsy revealed invasive squamous cell carcinoma of the vagina. Pap test was negative for malignant cells. Tumor marker studying including tumor antigen-4, CA-125, CA-19-9, and carcinoembryonic antigen were within normal range. On further staging, abdomen and pelvis magnetic resonance imaging (MRI) showed a vaginal tumor with invasion of urethra and clitoris and a 10 cm size solid mass in left adnexa. Positron emission tomography-computed tomography (PET-CT) and chest CT revealed multiple pulmonary and hepatic metastases (). Ultrasonography-guided biopsy of the left adnexa mass provided a histopathological diagnosis of metastatic squamous cell carcinoma. FIGO stage IVB vaginal cancer was diagnosed. The patient underwent palliative surgery including left salpingectomy, tumorectomy and clitoris mass excision. Due to severe adhesion, about 3 cm size remnant adnexa mass was left behind. The primary tumor at vagina was supposed to invade urethra and we decided to undergo on palliative CCRT. Microscopic pathology revealed metastatic squamous cell carcinoma involving ovary, salpinx and clitoris. The patient underwent CCRT. The major tumor and whole pelvis was treated with a total dose of 34 Gy over 17 fractions. 5-fluorouracil (5-FU) was administered at 1,000 mg/m2, in a 4-day continuous infusion schedule, combined 60 mg/m2 cisplatin (on day 1 of each course of 5-FU) for 6 cycles concurrent with radiotherapy. Follow-up abdomen & pelvis-CT taken one month after CCRT showed no evidence of tumor in vagina (). Chest CT also revealed complete disappearance of multiple pulmonary metastases (). After 20 months of treatment, multiple liver metastases have completely disappeared (). There was also no evidence of remnant adnexa mass. A complete remission was achieved. At a 40-month follow-up, there was no evidence of local recurrence or distant metastasis.