211 Vulvar and vaginal metastasis of sigmoid adenocarcinoma: a rare localization

Introduction Metastasis to genital tract are rare and usually secondary to breast and gastrointestinal malignancies. Vulvar and vaginal metastasis from Colon cancer are extremely rare with few cases reported in the litterature. Our case is unique because of simultaneous metastasis from sigmoid carcinoma to the vulva and vagina. It is to our knowledge the first case with this simultaneous localization of colorectal carcinoma. Case Report We present a case of 50-year-old woman with history of an adenocarcinoma of the sigmoid evolving since 2016 with liver metastasis. She underwent a sigmoidectomy without metastasis resection, followed by chemotherapy with folfox then LV5FU. After one year she presented with a vaginal bleeding associated to a vulvar mass. Clinical exam showed an enlarging firm not well defined and bleeding mass of the left labia major infiltrating the underlying tissue. Gynecologic exam showed a rigid and irregular mass infiltrating vaginal wall. The rest of the exam was normal. Tumors’ markers were negative. MRI and Ct scan showed a liver progression and vulvar mass infiltrating the vagin. Biopsy of the vaginal and vulvar masses concluded to a metastasis from the initial sigmoid tumor. The multidisciplinary meeting agreed to pursue the treatment with folfiri chemotherapy. Unfortunately, the patient passed away few months later. Conclusion vulvar metastasis counts for 2 to 8% of vulvar tumours. This case is unique because it reports a simultaneous localization to the vulva and vagina from colorectal carcinoma which is to our knowledge the first case in the literature.