Vaginal lesion as first manifestation of colorectal disease

A 73-year-old woman presented at Gyneacology Consultation with vaginal sensation of a lump. Physical examination revealed a vaginal exophytic lesion with 3 cm located at the right inner lip. The lesion was biopsied and histologic examination revealed infiltration by a mucinous adenocarcinoma. Immunohistochemical study suggested the diagnosis of colorectal aetiology. A subsequent colonoscopy demonstrated an ulcerated circumferential lesion at 8 cm from the anal verge Additional staging examinations revealed pulmonary metastasis and the patient was diagnosed with colorectal cancer stage IV. She was evaluated for chemotherapy and radiotherapy. We present an exceedingly rare case of true vaginal metastasis identified before the diagnosis of colorectal primary lesion.