Obstet Gynecol Sci.  2016 Sep;59(5):415-420. 10.5468/ogs.2016.59.5.415.

Primary malignant melanoma of cervix and vagina

• Lee JH
• Yun J
• Seo JW
• Bae GE
• Lee JW
• Kim SW

• KMID: 2391695
• DOI: http://doi.org/10.5468/ogs.2016.59.5.415

Abstract

Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.

Keyword

Cervix uteri; Primary malignant melanoma; Vagina

MeSH Terms

Acetabulum
Adult
Aged
Cervix Uteri*
Diagnosis
Drug Therapy
Female
Femur
Humans
Immunotherapy
Magnetic Resonance Imaging
Melanoma*
Neoplasm Metastasis
Prognosis
Recurrence
Thigh
Urinary Bladder
Uterine Cervical Neoplasms
Uterine Hemorrhage
Vagina*

Figure

• 

  Fig. 1 Magnetic resonance imaging findings. (A) About 8.6×7.3-cm enhancing cervical mass shows an invasion to the vaginal, bladder, and parametrium. It demonstrates mixed intermediate to subtle high signal intensity on T1WI. The white arrow indicates left sacral metastasis. (B) Right obturator lymph node metastasis is noted (yellow arrow). It shows heterogeneous intermediate to subtle high signal intensity on T2WI. (C) Right obturator lymph node metastasis and diffuse pelvic bone metastasis are noted (red arrow). It shows heterogeneous enhancement after contrast administration.

• 

  Fig. 2 (A) Highly atypical sheets of malignant cells reveal sufficient granular cytoplasm and prominent eosinophilic nucleoli. The atypical cells show diverse morphology from the spindle to epithelioid cells, and mixed in brownish pigments and abundant blood vessels (H&E, ×400 ). (B) Immunohistochemical stains for HMB45 (×200) were done. Antibodies against HMB 45 (melanosome) disclose diffused positive reaction against tumor cells. (C) Immunohistochemical stains for S100 (×100) were done. Antibodies against S100 protein disclose diffused positive reaction against tumor cells.

• 

  Fig. 3 (A) Colposcopic findings of primary malignant melanoma at vagina. It shows pinkish ulcerative lesion at lower vagina. (B) positron emission tomography-computed tomography (PET-CT) findings of recurrence of vaginal melanoma at left inguinal lymph node (white arrow). (C) PET-CT findings of recurrence of vaginal melanoma at right inguinal node (yellow arrow). (D) PET-CT findings of metastasis to multiple organs 37 months after the initial diagnosis, following three times of surgery and adjuvant therapy.

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