Primary amelanotic malignant melanoma of the vagina--a case report

A case of a primary amelanotic melanoma of the vagina is reported. The patient was a 58-year-old Japanese female. A polypoid tumor was found on the lateral wall of the vagina and a cytologic examination of a scraping showed a few large atypical cells with cleaved nuclei and intranuclear vacuoles. A lateral junctional spread was histologically observed and stage II melanosomes were found in the cytoplasm. Two years after a radical operation, the patient died of a widespread melanotic metastases. The authors survey the number of incidences of malignant melanoma in the female genital organ. In Japanese women, melanoma is seen more frequently in the vagina than in the vulva, which is quite the opposite in cases of malignant melanomas of the genital organs in women of the United States and Europe.     

Primary amelanotic melanoma of the cervix: case report with review of literature

Primary malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. It may be misdiagnosed especially when amelanotic, in which case immunohistochemistry is useful in reaching the diagnosis. We present one such case of a 65-year-old postmenopausal female patient presenting with bleeding per vaginum. Speculum examination revealed an ulcero-proliferative growth involving the cervix. On histopathological examination it was originally suspected to be a poorly differentiated carcinoma or a non-epithelial malignant tumor, but was subsequently correctly diagnosed by immunohistochemical staining with the HMB-45 antibody and S-100 protein.     

Primary breast synovial sarcoma: a rare primary breast neoplasm

A primary synovial sarcoma based on the breast is rare. The usual tumours on the breast are carcinomas. Synovial sarcomas account for about 6–9% of soft tissue sarcomas and most commonly develop in the extremity of young adults (80%). The other 20% of synovial sarcomas can arise in non-extremity sites (trunk 8%, retroperitoneal/abdominal 7%, head and neck 5%) but synovial sarcomas can develop in almost any other anatomical location. We report a case of a young woman who presented with a suspected common breast tumour and started treatment of this tumour with carcinoma neoadjuvant chemotherapy. We were surprised when the pathologist identified a synovial sarcoma in the histopathology study.     

Unusual presentation of metastatic amelanotic melanoma of unknown primary origin as a solitary breast lump

Breast is an uncommon site for metastasis from other malignancies especially melanomas. A 40-year-old lady presented with a rapidly growing, painless, solitary breast lump for 3 months. Past history was unremarkable for skin lesions, biopsy or any surgery. The lump was hard and freely mobile with normal overlying skin, nipple, and areola. Careful examination of the skin did not reveal any lesion. Grossly the tumor was partially circumscribed and gray white. Microscopically, a highly cellular lesion was seen showing nests and sheets of large anaplastic cells with atypical mitotic figures without any evidence of cytoplasmic pigment. Immunoreactivity for S-100 and HMB-45, confirmed the diagnosis of amelanotic melanoma. It is important to be aware of this atypical presentation of amelanotic melanoma in the breast and to utilize immunohistochemistry to differentiate from other commoner high-grade malignant tumors.     

Primary Malignant Amelanotic Melanoma in the Female Genital Tract：A Report of Six Cases and a Review of the Literature

OBJECTIVE To analyze the clinical characteristics,pathologic diagnosis,treatment and prognosis of amelanotic melanoma in the female genital tract (AMFGT).METHODS The medical records of 6 patients with AMFGT between 1991 and 2006 in our hospital were reviewed.RESULTS Of these cases,4 were preliminarily misdiagnosed as chorioepithelioma,sarcoma,adenocarcinoma or lymphoma.Two patients were determined to have AMFGT preoperatively after positive immunohistochemical staining for both S-100 protein and HMB-45.Specimens removed from all 6 cases were tested for immunohistochemical staining,as well as H & E histochemical stains.S-100 and vimentin were both positive in all patients,and HMB-45 was positive in 3 out of 5 patients.Four patients recurred (at 6,6,12 and 19 months) after primary treatments.Three patients died (at 13,18 and 19 months) after the initial diagnosis.CONCLUSION Because of an absence of pigmentation AMFGT is extremely difficult to diagnose.Combined immunohistochemical staining,such as the S-100 protein,HMB-45 and vimentin etc,is important in the evaluation of AMFGT.Correct diagnosis plays a crucial role in the treatment of this disease.     

Endocrine-responsive breast cancer and strategies for combating resistance

Deaths from breast cancer have fallen markedly over the past decade due, in part, to the use of endocrine agents that reduce the levels of circulating oestrogens or compete with oestrogen for binding to its receptor. However, many breast tumours either fail to respond or become resistant to endocrine therapies. By understanding the mechanisms that underlie this resistance, we might be able to develop strategies for overcoming or bypassing it.     

Acupuncture-related rapid dermal spread of breast cancer: a rare case

Many ethnic Chinese patients seek second or adjuvant alternative therapies after breast cancer is diagnosed. Chinese herbs and acupuncture are the most popular methods in East Asia. We present a case of acupuncture manipulation-related cutaneous spread that no literature reported before. Post-acupuncture cutaneous spread was noted in a 54-year-old woman with left neck lymph node recurrence after complete surgery, chemotherapy and radiotherapy treatment. The results of chest computed tomography and skin biopsy showed the metastatic breast cancer in the dermis. Six courses of paclitaxel and gemcitabine followed by trastuzumab were given as therapeutic chemotherapy. The neck mass and cutaneous lesions subsided after 2 courses of chemotherapy. Direct puncture of a metastatic lymph node might increase the incidence of tumor spread on the skin. Therefore, despite the efficacy of complementary and alternative medicine, its safety and possible side effects should be more emphasized.     

黏膜无色素性恶性黑色素瘤的免疫组化及临床研究

 目的 探讨CD56，CD95（Fas），Ki-67，p53，bcl-2，HMB45和S-100在恶性黑色素瘤（恶黑）中的表达，以提高黏膜无色素性恶黑的病理诊断准确率，减少误诊和漏诊，并为临床估计预后、选择治疗方案提供客观指标。方法 应用组织芯片和免疫组化标记技术，对48例黏膜无色素性恶黑进行标记和分析。结果 HMB45与S-100的阳性率分别是100 %和85.4 %（41／48）。CD56的阳性率为91.6 %（44／48），在转移灶与原发灶中差异无统计学意义（P＞0.05）。CD95的阳性率为85.4 %（41／48），其中在11例有淋巴结转移的病例中，阳性率达100 %。Ki-67与p53阳性率分别为79.2 %（38／48）和58.3 %（28／48），Ki-67的阳性分布与CD95基本一致。bcl-2的阳性率为39.6 %（19／48）。p53和bcl-2在恶黑中的表达阳性率与CD95比较差异具有统计学意义（P＜0.05）。结论 CD56在恶黑中具有重要的辅助诊断价值；CD95（Fas）与Ki-67的表达对判断恶黑浸润范围及淋巴结转移状况和指导临床治疗有一定的意义。     

Clinical and dermatoscopic diagnosis of early amelanotic melanoma

Amelanotic cutaneous melanoma (ACM) often defies clinical diagnosis because of the lack of pigmentation. In an attempt to find diagnostic clues, we retrospectively studied the clinical features of 15 thin (< 1 mm thick or Clark level I) ACM lesions. The clinical features of early ACMs are identified and illustrated to enable early diagnosis and cure of these lesions. The typical early lesion presents as an asymmetric macula, which may be uniformly pinkish or reddish or, more often, has faint light pigmentation (tan, brown or grey) at the periphery; it has borders that may be well- or ill-defined. In our study, these features suggested the correct clinical diagnosis in only a minority (40%) of cases. Nine cases in this series were also subjected to dermatoscopy. By this technique we identified, as constant feature, the presence of small red dots, evenly distributed or grouped on a whitish or pink-red background. Our results show the importance of dermatoscopy in the evaluation of equivocal pink or reddish lesions. Red dots seen with this technique can be an important sign for the diagnosis of thin ACM. Since this sign does not appear to be pathognomonic, the presence of an associated pigmentary network can be decisive in the differential diagnosis.     

原发性双侧乳腺癌

原发性双侧乳腺癌(PBBC)的总体发病率不高,但近年来有逐渐增高的趋势,所以有必要提高对这一疾病的认识.本文复习国内外的相关文献,系统阐述PBBC的病因、流行病学特点、诊断、治疗,特别是预防等相关问题.根据乳腺两侧的原发病灶间隔期是否超过6个月,将PBBC分为同时性和异时性.对于危险因素各家论述涉及较多,其中基因研究是热点所在,也是目前研究的重点.因为PBBC不是转移癌,它与单侧乳腺癌的愈后没有明显差别,所以一经确诊应该采取积极治疗.对于PBBC的预防方法,各家提出意见不一,其中也存在一些争论.     

Primary non-Hodgkin lymphoma and invasive ductal carcinoma in the same breast: a rare case report

Primary lymphoma of the breast is an unusual clinical entity. The coexistence in the same breast of an invasive ductal carcinoma is even rarer. We report a 69-year-old woman referred for further evaluation of a palpable mass in her right breast. She was diagnosed and treated for simultaneous primary lymphoma and invasive ductal carcinoma. Primary breast lymphoma should always be considered in the differential diagnosis of breast masses. The presence of both malignancies presents a challenge in treatment decisions.     

Primary breast cancer: the effect of primary ovarian irradiation

Between November 1957 and December 1963, 169 premenopausal and 177 postmenopausal patients were included in a randomized clinical trial. In the experimental group ovarian irradiation was given shortly after mastectomy. In the control group ovarian irradiation was planned for the time of first recurrence. The last published follow-up in 1974 [1] revealed a significant effect on disease-free survival both in premenopausal and postmenopausal patients. The latest results from a follow-up conducted in 1989 demonstrate a significant effect also on crude survival in both age groups. As expected, long-term effects are observed exclusively in the premenopausal cohort.     

Cystic hygroma of the breast: a rare lesion

Lymphangiomas are congenital malformations of lymphatic vessels. More than 50% of these lesions are present at birth; 90% are diagnosed by the age of 2. These lesions do not expand very rapidly but they tend to infiltrate surrounding tissues; their degeneration into malignant tumors is an extremely rare occurrence. They are mostly located in the neck region and the axilla; breast lymphangioma is very rare. Surgery is usually performed for aesthetic reasons and in order to make a differential diagnosis with other, more common lesions. The surgical procedure involves the excision of the mass; other methods, such as radiotherapy and sclerotherapy, have proved to be completely ineffective.     

Primary amyloidosis of the breast associated with invasive breast cancer

Amyloidosis is usually a systemic disorder. A localised form can involve the breast and may mimic breast cancer. We report a case of primary amyloid deposit confirmed by immunohistochemistry, occurring in a patient with early breast cancer and review other cases of breast involvement with various types of amyloid.