Diagnosis of recurrent rectal cancer deep into the vaginal wall by transvaginal endoscopic ultrasound-guided fine needle aspiration

Local recurrent rectal cancer may present with extraluminal lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is good for diagnosis of such an extraluminal lesion. A 51-year-old Asian female was diagnosed with uT3N0M0 rectal adenocarcinoma 31 months ago. She had undergone chemotherapy, radiotherapy and abdominoperineal resection (APR). Eight months ago, colonoscopy and computed tomography (CT) were unremarkable. Carcinoembryonic antigen was 1.1 ng/ml. Pelvic examination revealed a 3 × 2 cm firm soft-tissue mass palpable through the left vaginal wall. EUS revealed a mass in the left lateral vaginal wall measuring up to 21 × 27 mm in cross section without invasion of adjacent pelvic structures. Transvaginal EUS-FNA was performed with a 22-gauge needle. Final cytology confirmed recurrent rectal adenocarcinoma. Subsequent surgery also confirmed a 2.3 cm grade II adenocarcinoma. The tumor focally extended to the inked margin. The uterus and ovary specimen were negative for disease. We herein report a successful role of transvaginal EUS-FNA for early detection of recurrent rectal cancer at the vaginal wall after abdominoperineal resection (APR).

References

• 1 Phillips R K, Hittinger R, Blesovsky L. et al . Local recurrence following “curative” surgery for large bowel cancer: I. The overall picture.  Br J Surg. 1984;  71 12-16
• 2 Heald R J, Ryall R D. Recurrence and survival after total mesorectal excision for rectal cancer.  Lancet. 1986;  1 1479-1482
• 3 Lohnert M S, Doniec J M, Henne-Bruns D. Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences.  Dis Colon Rectum. 2000;  43 483-491
• 4 de Anda E H, Lee S H, Finne C O. et al . Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery.  Dis Colon Rectum. 2004;  47 818-824
• 5 Meyenberger C, Huch B oni, Bertschinger P. et al . Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer.  Endoscopy. 1995;  27 469-479
• 6 Sasaki Y, Niwa Y, Hirooka Y. et al . The use of endoscopic ultrasound-guided fine-needle aspiration for investigation of submucosal and extrinsic masses of the colon and rectum.  Endoscopy. 2005;  37 154-160
• 7 Rex D K, Kahi C J, Levin B. et al . Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer.  Gastroenterology. 2006;  130 1865-1871
• 8 Delpy R, Barthet M, Gasmi M. et al . Value of endorectal ultrasonography for diagnosing rectovaginal septal endometriosis infiltrating the rectum.  Endoscopy. 2005;  37 357-361
• 9 Dhamanaskar K P, Thurston W, Wilson S R. Transvaginal sonography as an adjunct to endorectal sonography in the staging of rectal cancer in women.  AJR. 2006;  187 90-98