Malignant melanoma in the thymus

A case of malignant melanoma in the thymus is reported. Diagnostic imaging demonstrated a left anterior mediastinal mass in a patient with giant pigmented nevus without malignant change. Histologic and cytologic specimens obtained from the tumor revealed that the tumor was malignant melanoma. Surgery revealed malignant melanoma in the left lobe of the thymus. Many cell nests of pigmented nevi were observed throughout the thymus. The malignant melanoma was thought to have originated from the nevocellular nevus in the thymus. This is the first report of malignant melanoma in the thymus.     

A large primary malignant melanoma of the female urethra

We present a case of large, primary malignant melanoma of the female urethra with poor prognosis in this case report. Malignant melanoma is one of the rare tumors of the female urethra and accounts for 0.2% of all malignant melanoma cases. Large (5.6 cm in diameter), primary malignant melanoma of the female urethra is exceedingly rare.     

Multiple Metastatic Malignant Melanoma Presenting Intraluminal Gallbladder Bleeding

We report a case of malignant melanoma of unknown primary origin presenting metastasis in various organs as well as intraluminal gallbladder bleeding due to gallbladder metastasis. A 58-year-old woman was diagnosed with stage IV metastatic malignant melanoma. Because she exhibited acute cholecystitis and hemobilia due to malignant melanoma of the gallbladder, laparoscopic cholecystectomy was performed to relieve the symptoms. The resected gallbladder specimen showed a pedunculated black mass indicating malignant melanoma. Pathologic examination and immunohistochemical analysis revealed malignant melanoma of the gallbladder. Only a few cases of gallbladder malignant melanoma presenting hemobilia have been reported; here we present our case, including the experience of multidisciplinary treatment.Key words: Gallbladder malignant melanoma, Hemobilia, Laparoscopic cholecystectomyMalignant melanoma can metastasize to various organs. Metastasis often occurs in the lungs, liver, brain, and gastrointestinal tract; however, reported cases of metastatic melanoma of the gallbladder are rare. Though gallbladder melanoma is usually asymptomatic, acute cholecystitis is the most common presentation among symptomatic cases. Other symptoms, such as obstructive jaundice, external biliary fistula, and hemobilia, are rare and found in very few reports. Here, we report a case of multiple metastases of malignant melanoma of unknown primary origin, for which we performed laparoscopic cholecystectomy to treat continuous bleeding from the gallbladder. We conclude that cholecystectomy is indicated for symptomatic stage IV gallbladder of melanoma cases, because the patient who underwent cholecystectomy not only experiences resolved symptoms but also maintained a survival benefit with improved quality of life.     

Rare tumour mimicking meninigioma: A case of primary intracranial amelanotic malignant melanoma with negative staining of S100 and HMB‐45

Primary intracranial malignant melanoma is a rare disease, and the imaging findings usually mimic meningioma. Diagnosis is based on histology. Here, we report a case of primary intracranial malignant melanoma in a Chinese patient. A 27‐year‐old man presented with a 1‐month history of headache. Magnetic resonance imaging findings resembled features of a meningioma. Craniotomy with tumour excision was done and confirmed to be S100 and human melanoma black 45‐negative primary intracranial malignant melanoma. There was no extracranial involvement. The 9‐month follow up was reported. To our knowledge, this is the first reported S100 and human melanoma black 45‐negative primary intracranial amelanotic malignant melanoma.     

Amelanotic malignant melanoma: about three cases

The amelanotic melanoma is a rare type of malignant melanoma. The purpose of this report is to point out this aspect of melanoma, whose diagnostic delay is frequent. We describe one localisation on the penis, rare in this kind of melanoma and two cases of the extremities, more frequent localization of the amelanotic melanoma. The therapeutic issues and recommendation are similar to the classical pigmented malignant melanoma.     

Oral malignant melanoma detected after resection of amelanotic pulmonary metastasis

INTRODUCTIONSolitary pulmonary metastasis from oral malignant melanoma is very rare.PRESENTATION OF CASEWe demonstrated a 84-year-old patient with a lung nodule that was diagnosed as malignant melanoma by video-assisted thoracoscopic resection. Because primary pulmonary malignant melanoma was extremely rare, the tumor was thought to be a metastasized from an occult primary lesion. A detailed physical examination revealed a black tumor in the oral cavity, and this was suspected to have been the primary. Resection of the hard palate tumor and dissection of the cervical lymph nodes were performed. The patient was simply followed up without further therapy at his request, and he died one year after surgery due to bleeding from a pleural metastasis of malignant melanoma.DISCUSSIONPrimary melanoma of the oral cavity is rare, accounts for 0.5% of all oral cancers, and 0.8–1.8% of all melanomas. Because of absence of symptoms in the early stage of the disease and the presence of the tumor in relatively obscure areas of the oral cavity, the diagnosis is unfortunately often delayed. In view of the rarity of primary lung melanoma, when lung tumor was diagnosed as malignant melanoma, detailed physical examination of the entire skin and mucosa including the oral cavity was necessary.CONCLUSIONOral malignant melanoma was very rare, but oral cavity should be examined when the pulmonary nodule was diagnosed as malignant melanoma.     

Primary malignant melanoma of the esophagogastric junction: Report of a case

INTRODUCTIONPrimary malignant melanoma of the gastrointestinal tract is very rare, especially in the stomach. We report an extremely rare case of primary malignant melanoma of the esophagogastric junction mainly situated in the stomach.PRESENTATION OF CASEThe patient was a 72-year-old woman who complained of shortness of breath due to severe anemia. Upper endoscopy revealed a soft easy-bleeding polypoid tumor just adjacent to the esophagogastric junction in the stomach. Biopsy of the tumor did not indicate a definite result, except malignant tumor. We performed total gastrectomy with splenectomy, and histological and immunohistological examination revealed malignant melanoma of the esophagogastric junction. She had no remote metastasis or lymphnodal metastasis at the point of surgery; however, she died of multiple metastases 11 months after the operation.DISCUSSIONA definite preoperative diagnosis of primary malignant melanoma was very difficult to make from the preoperative biopsy specimen. This present case was first misinterpreted as undifferentiated carcinoma, or malignant lymphoma. Following the diagnosis of malignant melanoma, the question arose as to whether this was primary or metastatic (as malignant melanoma from other sites is known to metastasize to the stomach). Finally this tumor was diagnosed as a primary one due to the pathologic characteristics such as the existence of junctional activities.CONCLUSIONWe report an extremely rare case of primary malignant melanoma of the esophagogastric junction present in the stomach.     

Cutaneous Malignant Melanoma

Cutaneous malignant melanoma occurs in three forms: lentigo maligna melanoma, superficially spreading melanoma, and nodular melanoma. The histology, the clinical development and the biological malignancy of these tumours differ. The purpose of the study reported here was to provide a clearer picture of the surface morphology of the malignant cells and to relate their fine structure to both the tumour type and the clinical development of the malignant melanoma. This investigation of 28 tumours from 22 patients of Scandinavian origin shows that at the electron microscope level there is no difference between malignant cells in the invasion nodulus of superficially spreading melanoma and nodular melanoma. The primary tumours were often built up of 2 or 3 differently differentiated cell clones. Metastases were built up of the same cells or cell clones that were found in the primary tumour. In several cases the surface of the malignant cells was folded, and covered with microvilli, microblebs and blebs. These surface alterations could be related in several cases to changes in the cytoskeleton of the cell (microtubuli and microfilament complexes). The clinical course of the malignant melanoma could best be correlated to the histogenetic type of tumour, depth of invasion, nucleus polymorphy and the quantity and arrangement of the microfilament complexes.     

HIF-1α与VEGF在皮肤恶性黑色素瘤中的表达

目的 探讨缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)与血管内皮生长因子(vascular endothelial growth factor,VEGF)在恶性黑色素瘤组织中的表达及其相关性.方法 采用免疫组织化学方法研究HIF-1α与VEGF分别在32例恶性黑色素瘤标本与11例健康皮肤标本组织中的表达.结果 32例恶性黑色素瘤中HIF-1α的阳性表达率为62.5%(20/32),VEGF的阳性表达率为84.8%(27/32);11例健康皮肤组织中HIF-1α的阳性表达率为9.1%(1/11),VEGF的阳性表达率为18.2%(2/11).健康皮肤组与恶性黑色素瘤组间比较,HIF-1α与VEGF的表达差异有统计学意义,且恶性黑色素瘤组的HIF-1α与VEGF的表达呈正相关(P<0.05).结论 ①HIF-1α、VEGF在恶性黑色素瘤中呈高表达,提示其可能参与了恶性黑色素瘤的发生和发展.②HIF-1α、VEGF在恶性黑色素瘤组的表达呈正相关,提示恶性黑色素瘤中的HIF-1α可能参与了对VEGF的调控.     

阴茎原发恶性黑色素瘤4例

目的 探讨阴茎原发恶性黑色素瘤的临床症状、病理特点及诊断治疗.方法 对4例阴茎原发恶性黑色素瘤的病理和临床资料进行回顾性分析.结果 4例均行阴茎部分切除,双侧腹股沟淋巴结清扫术.术后4例均行化疗,其中2例化疗联合生物学治疗.结论 阴茎原发恶性黑色素瘤临床罕见,确诊依靠病理,手术为主要治疗手段,术后行化疗联合生物学治疗可提高生存期,但因其恶性程度高,预后不佳.     

Malignant melanoma presenting as a mediastinal mass

A case of malignant melanoma presenting as a mediastinal mass without an extrathoracic primary is reported. Microscopically the tumor appeared consistent with malignant melanoma, with the presence of focal melanin pigment in large epithelioid cells. Fontana stain confirmed the presence of melanin pigment. Immunohistochemical staining further suggested melanoma, with the tumor cells expressing a HMB45+, S100+ and cytokeratin-phenotype. Electron microscopy showed an abundance of melanosomes confirming the diagnosis of malignant melanoma.     

Primary malignant melanoma of proximal tibia

Primary malignant melanoma (clear cell sarcoma) of bone is a very rare neoplasm. Although metastatic melanoma to bone is not uncommon, primary malignant melanoma of bone is extremely uncommon. To date, only nine cases have been reported in the English literature. In this report, we present a case of primary malignant melanoma arising from the medial aspect of the proximal tibia in a 26-year-old woman. We treated the patient with above-knee amputation without any chemotherapy or radiotherapy. At final follow-up of 18 months, the patient was free of disease.     

Primary malignant melanoma of the right colon

The small and large intestines are the most common sites for metastases from cutaneous malignant melanoma. However, primary melanomas in these sites are exceedingly rare. There are several case reports of patients with primary melanoma of the small bowel, but finding of a solitary primary melanoma in the colon is exceedingly rare. We describe a patient that was operated on for bowel obstruction due to colonic intussusception resulting from a right colonic tumor. Histopathological examination confirmed a diagnosis of malignant melanoma. A thorough postoperative investigation did not reveal a primary lesion in any other site. Two years after surgery, there was no evidence for recurrent disease. The treatment and prognosis of metastatic and primary melanoma of the gastrointestinal tract is discussed as well as the embryonic base for development of primary malignant melanoma of the intestine. Primary malignant melanoma of the intestine is an extremely rare lesion that may arise in the large bowel as well. It must be differentiated from other intestinal tumors and mandates a thorough investigation to rule out the possibility of being a metastasis from another more common primary site.     

Primary malignant melanoma presenting as superior mediastinal mass

Malignant melanoma accounts for 1.5% of all cancers, and arises from a preexisting nevus in 40% of cases. Skin is the most common site for primary malignant melanoma. We present an extremely rare case of primary malignant melanoma presenting as a superior mediastinal mass.     

Collision malignant melanoma and medullary carcinoma of the thyroid

This report presents the case of a 54‐year‐old woman with a collision tumour of malignant melanoma and medullary thyroid carcinoma in the thyroid. Twenty four of 25 neck lymph nodes contained metastatic melanoma, with the rest having both metastatic melanoma and medullary carcinoma. Systemic chemotherapy was administered for the malignant melanoma, and a complete response was thus obtained. However, just after having the chemotherapy, multiple lung and brain metastases emerged. The simultaneous occurrence of malignant melanoma and medullary carcinoma in the same thyroid has not been previously reported in the literature. Collision tumour of malignant melanoma and medullary carcinoma of the thyroid might imply bad prognosis.     

Malignant Melanoma of the Kidney Presenting as a Primary Tumor

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 74-year-old woman. The patient underwent a right radical nephrectomy, and has been living tumor free for 2 years and 3 months. This is the first reported case of primary renal malignant melanoma. We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.     

Malignant melanoma of the foot and ankle

Malignant melanoma is a serious and devastating skin disease that podiatrists may be called upon to treat. It is pertinent that delays in diagnosis and treatment of malignant melanoma be avoided. Some of the topics discussed in this article are causes, clinical features, classification, and treatment of malignant melanoma, focusing on the foot and ankle.     

A case of malignant melanoma of the transverse mesocolon

A pediatric patient with malignant melanoma of the transverse mesocolon is reported. No cases of malignant melanoma occurring from the mesenterium have been previously reported in the literature.     

Differential diagnosis of occult primary malignant melanoma]

Controversy exists in literature about therapy and prognosis of malignant melanoma of unknown primary site. We investigated frequency, differential diagnosis and follow-up of patients with occult primary malignant melanoma treated at the University of Leipzig in 1996. Among 135 patients with malignant melanoma (MM) seven were found without known primary. In two of seven cases the medical history pointed to regression of primary lesion of skin. In another two cases the diagnosis "melanoma" was changed to "lung cancer" after autopsy and in one case there was a relationship to a naevus blue resected nine months before. Recurrences or metastases occurred within six months after therapy. Two patients are still alive free of disease after a follow up of 33 and 24 months. Five patients died from tumor progression between 2 to 14 months postoperatively. Pitfalls in differential diagnosis and ways to find out the primary are discussed. Patients with unknown primary malignant melanoma should be treated similar to those with known primary. Radical surgery is indicated because it's impossible to determine the prognosis of patients with unknown primary malignant melanoma.     

A case report of anorectal malignant melanoma with mucosal skipped lesion

IntroductionWe report our experience involving a case of relatively rare anorectal malignant melanoma with skipped lesion.Presentation of caseThe patient was a 72-year-old man who had visited a local clinic complaining of a mass in the anal region, whereupon he was referred to our hospital on suspicion of a malignant melanoma. Close examination revealed a 25-mm black type 1 tumor one-third the size of the circumference of the anal canal and located externally to it. We performed transanal resection of the tumor and confirmed a diagnosis of malignant melanoma. Notably, multiple macular black lesions spaced away from the main lesion were observed during surgery in half of the circumference of the anal canal, from the tumor to the pectinate line. A biopsy of the area also revealed malignant melanoma; therefore, we performed abdominoperineal resection. Pathological diagnosis indicated a submucosal depth; the patient was thus diagnosed with T4 N2c M0 stage IIIb malignant melanoma and was followed on an outpatient basis.DiscussionPatients with anorectal malignant melanoma have very poor prognoses owing to early lymph node metastasis and hematogenous metastasis. Our case illustrates that small anorectal malignant melanoma lesions can spread from the main lesion and invade the mucosa; examinations may sometimes miss such skipped lesions.ConclusionSkipped lesions can occur in anorectal melanomas; thus, careful scrutiny of such lesions is required. Moreover, lesion resection is critical for anorectal malignant melanomas.