An unusual case of post-menopausal bleeding.

Area of Science:

• Oncology
• Urology

Background:

• Renal cell carcinoma (RCC) metastasis at presentation is common, typically affecting the lungs, bone, and liver.
• Synchronous vaginal and cervical metastasis from RCC is exceptionally rare, with blood reflux from the left renal vein to the ovarian vein being a proposed pathway.
• Metastatic tumors to the vagina are more frequently secondary to gynecological cancers (cervix, endometrium, ovary) than primary vaginal tumors.

Purpose of the Study:

• To report an extremely rare case of vaginal metastasis from renal cell carcinoma presenting as post-menopausal bleeding.
• To emphasize the importance of a high index of suspicion for diagnosing rare metastatic patterns of RCC.
• To discuss the diagnostic and management considerations for vaginal metastasis of renal origin.

Main Methods:

• A case presentation of a 55-year-old woman with post-menopausal bleeding.
• Physical examination revealed a vaginal mass obscuring the cervix.
• Diagnosis was confirmed via biopsy and immunohistochemistry, identifying renal cell carcinoma metastasis. Imaging identified a primary left renal mass and further metastases.

Main Results:

• The patient presented with a vaginal mass and confirmed vaginal, cervical, and pulmonary metastases from a left renal mass.
• Histopathological examination confirmed metastatic renal cell carcinoma.
• The patient was initiated on Pazopanib treatment.

Conclusions:

• Vaginal metastasis presenting as post-menopausal bleeding is an exceedingly rare manifestation of renal cell carcinoma, with only three prior cases reported.
• A high index of suspicion, thorough examination, and comprehensive investigation are critical for the accurate diagnosis and management of such rare presentations.
• While secondary vaginal tumors are more common, this case underscores the possibility of RCC as a source, necessitating a broad differential diagnosis.