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Adenocarcinoma Arising in a Rectovaginal Fistula in Crohn Disease

Chu, Mary M.D.; Crist, Henry M.D.; Zaino, Richard J. M.D.

International Journal of Gynecological Pathology: September 2010 - Volume 29 - Issue 5 - p 497–500
doi: 10.1097/PGP.0b013e3181d0cb2c

Adenocarcinomas occurring in the vagina are rare. Their correct classification may be very challenging to both the gynecologist and the pathologist, but it is essential for appropriate therapy. Although most adenocarcinomas in the vagina arise from other sites in the female genital tract, a significant minority reflects metastasis from a colorectal site. We report a very unusual occurrence of an adenocarcinoma that presented as a mass in the vagina protruding through the introitus. It arose in a rectovaginal fistula consequent to chronic Crohn disease, but it did not extend to involve the colonic mucosa. Neither the initial clinical examination nor the pathologic examination suggested the correct diagnosis. We report this case to remind the gynecologists of the potential complications of Crohn disease, and to highlight for the pathologists the difficulty that is often encountered in the correct identification of the source of carcinomas that are found in the vagina.

Department of Obstetrics and Gynecology (M.C.)

Department of Pathology (H.C., R.J.Z.), M.S. Hershey Medical Center, Hershey, Pennsylvania

Funding sources: none.

Conflicts of interest: none.

Address correspondence and reprint requests to Richard J. Zaino, MD, Department of Pathology, M.S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. e-mail:

©2010International Society of Gynecological Pathologists