Title: Cervical and vaginal metastases from ascending colon cancer: a case report and literature
review
Version: 0 Date: 07 Apr 2025
Reviewer:  Renato Moretti-Marques
Reviewer's report:
This case report addresses an infrequent presentation of synchronous cervical and vaginal
metastases originating from ascending colon cancer, offering both a clinical case and a review
of the relevant literature. The manuscript aligns with the aims and scope of BMC Women’s
Health, as it provides valuable insight into a metastatic pattern that directly impacts gynecologic
oncology and women’s health care.
The report presents a well-documented clinical case with appropriate diagnostic and therapeutic
steps. The immunohistochemical analysis (CK7-negative, CK20-positive, CDX2-positive) was
thorough and supports the conclusion of a colorectal origin. The clinical reasoning is sound,
and differential diagnoses, including primary cervical/vaginal adenocarcinoma and Lynch
syndrome, are appropriately considered, and excluded. This diagnostic approach contributes to
the manuscript’s scientific rigor.
The paper's structure is logical, with a clear abstract, introduction, case description, and
discussion. The language is understandable, though several instances of repetition and overly
long sentences exist, particularly in the debate. A more concise writing style would improve
clarity and readability. The introduction could also be streamlined to avoid repeating content
from the abstract.
The discussion provides a detailed analysis of the possible metastatic pathways involved,
including peritoneal seeding and hematogenous dissemination via the Batson venous plexus.
While this anatomical and physiological explanation is informative, it could be more succinct in
enhancing the focus on the clinical implications. The rationale for omitting lymphadenectomy
during surgery should be explained more clearly, especially given the confirmed metastatic
disease.
Although the authors conducted a literature review, it lacks a systematic methodology and could
be explained, including a comparative table of previously reported cases with cervical and/or
vaginal metastases from colorectal cancer would enhance the value of this report and place the
current case in more precise context.
The images provided (HE, immunohistochemistry, and MRI) are of excellent quality and
effectively support the narrative. Ethical aspects should be discussed because they are adequately
addressed, and appropriate patient consent is documented, although the ethics committee was
not informed.
The conclusion emphasizes the importance of considering metastatic disease in patients with
gynecological symptoms following colorectal cancer, even years after primary treatment.
However, the recommendation of radical surgery should be more cautiously framed, given that
most patients with similar presentations may have limited prognosis and systemic disease. It
would be helpful to include a comment on the multidisciplinary decision-making process and
the potential role of systemic therapy or palliative care in similar future cases.
This is a relevant and well-constructed case report that adds to the limited literature on this
subject. The rarity of the case, the detailed pathological analysis, and the comprehensive
surgical management make it a valuable contribution to the field. However, revisions are
recommended to improve clarity, reduce redundancy, and strengthen the discussion with more
robust contextualization and critical analysis.