Solitary Metastasis in the Tibia as a Feature of Primary Squamous Vaginal Carcinoma

Abstract

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.