Primary malignant melanoma of the female genital tract synchronously involving the vulva and uterine cervix

Abstract

Rationale Primary melanomas of the female genital tract are rare and usually occur in the vulva and vagina. Involvement of the cervix, uterus, and ovary are extremely rare. Surgery and adjuvant therapy remain the mainstay of treatment. The majority of patients experience poor long-term survival. This report aimed at highlighting an extremely rare case of primary melanoma of the female genitalia, synchronously involving the vulva and uterine cervix. Patient concerns A 58-year-old multiparous female presented with postmenopausal bleeding for 10 days. Diagnoses Speculum examination and histologic analysis of the surgical specimens revealed synchronous involvement of the vulva and uterine cervix by malignant melanoma. According to the American Joint Committee on Cancer stage grouping for melanoma, this tumor was at stage V. Interventions The patient subsequently underwent radical surgery and postoperative chemotherapy. Outcomes She has been on regular follow-up, and is now free of disease for 50 months after the operation. Lessons Primary melanomas of the female genital tract have biologically aggressive characteristics. Optimal management consists of individualized surgery and adjuvant therapy. However, early recognition and prompt intervention offer maximal benefit from treatment.

Primary Malignant Melanoma of the Cervix: A Case Report and a Review of the Literature

“…It has been reported that although the cervix is usually the origin of MM, almost 20% of all cervical MM are metastatic [ 22 ]. Secondary involvement of the cervix from a MM occurs either with locoregional spread of vaginal/vulvar carcinomas or with hematogenous metastasis of a distant primary MM [ 8 , 42 ]. Multifocal presence of melanoma foci in multiple sites can prove the diagnosis very challenging.…”

“…The first well-documented case of primary malignant melanoma of the cervix (PMMC) was reported in 1944, by Taylor and Tuttle [ 6 ]. Since then, to this day, less than 100 cases of PMMC have been described [ 7 , 8 ]. The diagnosis of PMMC can be proven very challenging due to the rarity of the disease and also due to the wide variety of cytomorphologic characteristics [ 9 , 10 ].…”

Cytology of an ulceroproliferative cervical mass

“…It can present as an amelanotic/melanotic nodule/polyp or an ulceroproliferative mass. The patient presents with the complaint of bleeding per vagina/mass per vagina/anaemia …”

“…Masson-Fontana and Schmorl's stains can distinguish melanin pigment from many other brown-black pigments and this tumour is positive for S100 (nucleocytoplasmic), HMB45 (cytoplasmic) and Melan-A (cytoplasmic) immunohisto-chemistry. It can be also positive for CD117 (c-kit) and BRAF based on its molecular pathogenesis 2,3.…”

Ultrasonographic Diagnosis of Rare Primary Cervical Cancer

“…Cervical squamous cell carcinoma (CSCC) is the most common primary tumor in the cervical region; other rare primary tumors include clear-cell carcinoma of the cervix (CCCC) and small-cell carcinoma of the cervix (SCCC), [1][2][3] primary lymphoma of the cervix, 4 cervical choriocarcinoma, 5 sarcoma of the uterine cervix, 6 rhabdomyoma of the cervix, 7 malignant melanoma of the cervix, 8,9 Wilm's tumor of the cervix, 10 and malignant peripheral neurilemmoma of cervical broblasts. 11 Regardless of the type of cervical neoplasm, contact hemorrhage or uor sanguinolentus are the main early clinical manifestations; late clinical manifestations include irregular vaginal bleeding of varying amounts with corresponding symptoms of distant metastasis.…”