Introduction/Background Primary vaginal malignant tumors are rare, and vaginal metastases account for the majority of vaginal malignancies.Most of these metastases arise from the cervix, endometrium or ovary, although they can also metastasizes from distant sites such as the colon and the rectum.

Methodology We report the case of a patient who presented with vaginal metastasis of colorectal adenocarcinoma. Unexpectedly, the tumor was a metastatic carcinoma derived from an upper rectum cancer.

Results The presented case report describes a 64-year-old female patient with a history of hypertension, diabetes, dyslipidemia. The patient initially presented with an upper GI hemorrhage and an altered general condition. Initial colonoscopy revealed a stenosing ulcerative process 18 cm from the anal margin, which was later confirmed to be a colloid carcinoma of the rectum. The patient underwent anterior resection of the rectum with colorectal anastomosis, followed by adjuvant chemotherapy with 6 cycles of Folfoxwith good overall tolerance. However, at 1 month from the end of the chemotherapy the patient consulted for low grade metrorrhagias. Speculum examination showed a budding mass centered on the cervix and anatomopathological examination concluded to vaginal recurrence of a mucous colloid adenocarcinoma. The thoracic-abdominal-pelvic CT scan had not shown any remote secondary locations and the patient is actually proposed for concomitant radio chemotherapy with capecitabine.

Conclusion Patients with pelvic pain or metrorrhagia should be evaluated for vaginal metastases from colorectal cancer, as their detection can be challenging due to their rarity and lack of specific guidelines.

Disclosures The authors have no conflicts of interest to declare.