PMC3930582_01
A solid nodular lesion of the anterior vaginal wall appears faintly hyperintense on TSE-T2 sagittal plane (A) and hypervascularized on T1-VIBE contrast enhanced sagittal plane (B). T1-VIBE contrast enhanced axial plane (C) shows a stenosing thickening of the sigmoid wall.
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MRI confirmed the presence of a solid infiltrating nodular lesion (22x25 mm axial diameters) at middle-inferior level of the anterior vaginal wall, isointense on T1w and faintly hyperintense on T2w images respect to the muscle, hypervascularized on the contrast enhanced sequence (Figure 1A, 1B). Moreover a stenosing thickening of the sigmoid wall, 4 cm in longitudinal extension, was observed (Figure 1C).
On microscopic examination the vaginal mucosa was infiltrated by an adenocarcinoma of intermediate grade, with focal necrosis. Microphotographs of vaginal biopsy (A) showed the stroma infiltrated by neoplastic glands (yellow arrows) beneath the intact squamous epithelium of vagina [hematoxylin-and-eosin stain (H&E) magnification, 40x]. The immunostaining showed the neoplastic glands strongly positive for cytokeratin 20 (B) and CDX2 (C); the cytokeratin 7 and estrogen receptors were negative [400x]. On the basis of the morphology and immunohistochemical profile a diagnosis of vaginal infiltration by colonic adenocarcinoma was made.
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The histological examination disclosed an adenocarcinoma of the sigmoid colon associated to a vaginal metastasis (Figure 2).