Case of primary amelanotic malignant melanoma of the female urethra

We report a rare case of primary amelanotic malignant melanoma of the female urethra. A 58-year-old female with complaint of nodule on the external urethral meatus was referred to our hospital. Pathological diagnosis of the biopsy specimen from the nodule was malignant melanoma. Computed tomography of the chest and abdomen as well as bone scan showed no evidence of metastasis. Sentinel biopsy from the inguinal lymph nodes revealed no metastasis. Thereafter, the patient underwent radical urethrectomy, whose limits of resection were the bulbocavernosal muscles bilaterally, the arch of the pubic symphysis anteriorly, the anterior vaginal wall posteriorly, and the urethra up to the level of the bladder neck superiorly. The histopathological diagnosis was amelanotic malignant melanoma of the urethra. The patient had received six cycles of DAV-Feron (dacarbazine, nimustine, vincristine, and interferon-beta) in an adjuvant setting, and there is no sign of recurrence 25 months after operation.     

Primary malignant melanoma of the male urethra

BACKGROUND: We describe a rare case of malignant melanoma originating from the male urethra. METHODS/RESULTS: This case, which presented a tan-colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra. CONCLUSIONS: In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non-specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra.     

Primary malignant melanoma of the female urethra. Report of a case

Primary malignant melanoma of the female urethra is a rare tumour with great agressivity and poor prognosis. An early diagnosis may benefit of radical surgery and adjuvant immunotherapy with curative effect. We present a sixty-five years old female with a malignant melanoma of urethra and a secondary additional melanoma in vulva, that was treated with both radical ureterectomy and vulvectomy. A bilateral inguinal lymphadenectomy and immunotherapy with alpha-interferon were added. The patient is free of disease one year postoperatively.     

女性尿道原发性恶性黑色素瘤3例报告

目的：探讨女性尿道原发性恶性黑色素瘤的临床特征及治疗手段。方法：对3例女性原发性尿道恶性黑色素瘤进行临床病理分析及随访观察。结果：3例均以尿道外口包块就诊。2例因术前诊断不清，仅局部切除，其中1例术后半年死于肿瘤复发。1例正在随访中；1例行全尿道切除，双侧腹股沟淋巴结清扫及永久性膀胱造瘘。结论：女性尿道原发性恶性黑色素瘤恶性度高，临床易误诊，早期确诊的主要依据是病理学检查，及时规范手术是提高患者生存率的主要手段。     

Malignant melanomas of female urethra

Primary melanoma of the female urethra is extremely rare. Treatment by surgery, radiation, and chemotherapy has been uniformly ineffective. We herein report on 2 patients with primary malignant melanoma of the urethra treated with immunotherapy and chemotherapy. The first patient died four years after the initial diagnosis, and the second died after two years. Chemo-immunotherapy may be considered as an additional, palliative form of treatment in the management of primary melanoma of the female urethra, but cystourethrectomy should be the initial form of treatment.     

Primary malignant melanoma of the female urethra: Report of a rare neoplasm of the urinary tract

IntroductionMelanoma is a malignant tumor that can affect any area of the anatomical economy. Its occurance in the female urethra is extremely rare. We report a case of primary malignant urethral melanoma developed in an elderly female patient.Presentation of caseA 70 years old female presented with dysuria, poor stream, gross haematuria, intermittent blood spots, and a painful mass. On physical examination, there were no suspicious lesions on the skin. On external genital examination, a lesion at the level of the urethral meatus was observed. The mass was removed by wide local excision under spinal anaesthesia. The pathological diagnosis was malignant melanoma of the urethra.DiscussionThe common presentations include bleeding and/or discharge per urethra, voiding dysfunction and the presence of tumor mass. Survival depends on the stage, location and size of the neoplasm at the time of diagnosis. Despite major surgery, radiotherapy or immunotherapy; malignant melanoma usually has a poor prognosis.ConclusionMelanoma of the female urethra is an extremely uncommon pathology leading to paucity of literature and any definite recommendations regarding management. The histological and immunohistochemical findings can be helpful in making an early and accurate diagnosis of malignant melanoma in the urogenital region.     

Primary malignant melanoma of the male urethra.

We report a case of primary malignant melanoma of the male urethra, increasing the total number of reported cases to 31. The experience with our case suggests that urinary cytology is a diagnostic method for malignant melanoma and essential in the preoperative diagnosis of this disease.     

原发性女性尿道黑色素瘤(附4例报告)

目的　探讨女性尿道原发性恶性黑色素瘤的临床特征及治疗方法。方法　对4例女性原发性恶性黑色素瘤进行临床病理分析及随访观察。结果　4例患者均为尿道外口肿物就诊。2例因术前诊断不清,仅作局部切除,其中 1 例术后 16 个月死于肿瘤复发,1例仍在随访中;另2例行全尿道切除,双侧腹股沟淋巴结清扫及永久性膀胱造瘘。结论　女性尿道原发性黑色素瘤恶性度高,临床易误诊,早期诊断的主要依据是病理学探查,及时规范手术是提高患者生存率的主要方法。     

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.     

Primary amelanotic malignant melanoma of the female urethra

The case is reported of amelanotic malignant melanoma of the female urethra mimicking urethral caruncle. A 75-year-old woman complained of a mass of the external meatus. Urethral carunclectomy was performed, but histological diagnosis was amelanotic malignant melanoma. Finally, she underwent en block resection of urethra including bladder neck, uterus, adnexa, vagina, and vulva. As urinary diversion, she underwent a continent cathererizable stoma with an appendicovesicostomy, according to the method described by Mitrofanoff, and Y-V graft for reconstruction of the vulva.     

Primary genitourinary melanoma presenting as voiding dysfunction

A case of primary malignant melanoma of the urethra in a 67-year-old female is presented. Cystourethroscopy performed during a workup for pelvic organ prolapse revealed a bladder and urethral mass. Initial histologic examination was interpreted as undifferentiated sarcoma; however, after immunohistochemical staining by two separate institutions, malignant melanoma was diagnosed. Being rare, urethral melanoma is often misdiagnosed, and treatment can be delayed. Given its poor prognosis, early diagnosis is essential, and clinicians need to include it in their differential when working up a patient with genitourinary complaint.     

Primary malignant melanoma of the female urethra: a case report

A 72-year-old female with a complaint of hemorrhagic leucorrhea was referred to our department. She had a black tumor on her urethral meatus suspected as a malignant melanoma. Urethrectomy, vulvectomy, partial vaginectomy, bilateral inguinal lymphadenectomy, and cystostomy were performed. Pathological diagnosis was malignant melanoma of the urethra. Local recurrence and lymph node metastasis were found 9 months later, and she has been given DAV-feron combined therapy.     

Primary malignant melanoma of the female urethra: A case report

A case of primary malignant melanoma of the female urethra is reported. Physical examination and visceral studies confirmed the primary character of the tumour and histologic examination proved it to be nodular malignant melanoma. Less than 100 cases have been previously reported. The role of immunohistochemical stains to substantiate the diagnosis is stressed. Therapy and prognosis are briefly discussed.     

Primary malignant melanoma of the female urethra

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.     

Primary malignant melanoma of the male urethra

We report a case of primary malignant melanoma of the male urethra in a patient whose penile shaft was successfully preserved, but who proceeded to acute renal failure (ARF) after interferon (IFN)-beta adjuvant immunotherapy. Primary malignant melanoma of the male urethra is rare and usually shows highly malignant potential. Therefore, urologists must often perform phallectomy, which impacts on the patient both sexually and mentally. A 64-year-old man presented at Saiseikai Sendai Hospital with asymptomatic gross hematuria and was diagnosed as distal urethral tumor. We predicted the highly malignant potential of this tumor from the urethroscopic finding and from urinary cytological examination. We did not select trans-urethral resection (TUR), but selected partial urethrectomy. This patient proceeded to ARF 1 month after natural IFN-beta treatment as an adjuvant immunotherapy. As IFN-beta rarely induces the delayed renal failure, urologists should be aware of renal dysfunction after IFN-beta therapy for the treatment of malignant melanoma.     

Primary malignant melanoma of the male urethra

Primary malignant melanoma of the male urethra is a rare disease, with only 24 cases previously reported in the literature, including 1 black patient. We describe 2 additional patients with primary malignant melanoma of the urethra, one of whom was a black man. The literature is reviewed briefly and treatment recommendations are discussed.     

Benign melanosis and malignant melanoma of penis and male urethra

Malignant melanoma of the penis and male urethra are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.     

女性尿道恶性黑色素瘤：附三例报告

报告原发性女性尿道恶性尿道恶性黑色素瘤３例，结合文献复习对其发病情况、临床过程、诊断，治疗及预后进行讨论。     

Primary melanoma of the urethra: a rare neoplasm of the urinary tract

Primary melanomas of the genitourinary tract are rare and constitute less than 1% of all melanomas. Since the clinical presentation of urethral melanoma is similar to commoner urothelial carcinomas, there is frequent delay in diagnosis. A 65-year-old female presented with bleeding per urethra for 1 month. Cysto-urethroscopy showed a gray–white polypoidal tumor in the distal urethra. A biopsy from the tumor showed sheets of cells with moderate cytoplasm, and central vesicular nucleus with prominent nucleolus. Immunohistochemistry for HMB-45 and S-100 protein was positive in the tumor cells. A diagnosis of urethral melanoma was made and radical cysto-urethrectomy with total hysterectomy was done. There was no residual tumor in the urethra; however, sections from bladder neck showed pagetoid spread of melanoma cells in urothelium. No melanocytic lesion was found elsewhere, and a diagnosis of primary melanoma of urethra was rendered. Urethral melanomas are rare tumors, having clinical presentation similar to much commoner urothelial neoplasms. Due to the poor prognosis, the clinician and the pathologists should keep this diagnosis in mind when dealing with urethral tumors with unusual morphology.     

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.