Does primary melanoma of the bladder exist?

Primary melanoma of the urinary bladder is a rare neoplasm to which very strict diagnostic criteria apply. Although reports of previous cases exist, these criteria have yet to be met. We report a case of a young lady from whom a malignant melanoma of the bladder was resected. This was presumed to be primary as detailed investigation failed to find any other site from which metastases could have originated. We discuss the diagnostic criteria of this entity and stress the difficulty in conclusively demonstrating that, despite some of these criteria being met, a lesion such as this is primary in origin. This case could be the longest surviving patient with primary melanoma of the bladder, however we will never be able to prove that spontaneous regression of an undiagnosed extravesical primary malignant melanoma did not occur.     

Primary malignant melanoma of the distal urogenital tract. Case report and review of the literature

The primary manifestation of a malignant melanoma is rarely found in the female urethra and considerably less in urinary bladder. This article is based on a case report of a female patient who had to undergo numerous transurethral resections and died of such an escalating tumor. Malignant melanoma in the form of metastases are relevant to the urologist, because they are discovered frequently in the genitourinary tract. The symptoms and diagnostic procedures correspond to those of other urological carcinomas. Radical surgery is of major importance as therapy.     

Metastatic malignant melanoma of the urinary bladder: a case report

A 77-year-old male was admitted to our department with the chief complaint of positive occult blood in urine on July 30, 1984. Endoscopically, we found a dark red tumor on the left posterior wall of the urinary bladder, which seemed to have coagula covering it. On August 31, transurethral resection of the bladder tumor (TUR-Bt) was performed, and the pathological interpretation was malignant melanoma. Dermatologically and ophthalmologically, we could not found the primary foci. A month later, cystoscopy demonstrated multiple blue black spots consistent with diffuse melanoma of the bladder. On May 7, 1985, he was admitted to our clinic with right hypochondralgia. On physical examination, the liver was palpable with an irregular surface, and the echogram showed multiple metastasis in the liver. TUR-Bt was carried out again, on May 17, 1985. Ultrastructually resected specimens demonstrated a lot of mature melanosomes in the tumor cells. The course of the patient progressively worsened, and he died on May 30, 1985. At autopsy, we found metastases in the central nervous system, bone, genitourinary tract, gastrointestinal tract and other organs. The left eye ball, which had been diagnosed as ophthalmomalacia by glaucoma six years earlier, was filled by a melanoma mass, and it seemed to be the primary foci.     

Metastasis of malignant melanoma in the ureter: Possible algorithms for a therapeutic approach

Abstract:   We report on the very rare case of a patient with a malignant melanoma in the right ureter initially hospitalized for colic pains. Ureterorenoscopy revealed a pigmented solid mass adherent to the mid-ureteral wall. Histomorphological and immunohistochemical examination of the biopsy specimen demonstrated a malignant neoplasia with HMB45, Melan A and S100 positivity establishing the diagnosis of metastatic malignant melanoma. Hence, partial ureterectomy was performed with no further evidence of disease at the time of surgical intervention. Subsequently, multiple metastases in the renal pelvis and ureter led to secondary nephroureterectomy and retroperitoneal lymphadenectomy with complete excision of the ureteral orifice. Secondary metastatic lesions of the urinary bladder wall were completely resected followed by dacarbazine-based chemotherapy and resection of retroperitoneal recurrences. Based on this case as well as on recent published reports, we propose a possible algorithm for the treatment of metastatic melanoma of the upper urinary tract.     

膀胱原发性恶性黑色素瘤1例并文献复习

目的 观察原发性恶性黑色素瘤的病理形态、免疫组化和电镜特征,进一步探讨其组织起源和鉴别诊断,指导临床诊治.方法 用组织病理学、免疫组化、透射电镜方法进行观察,并结合国外文献资料进行探讨.结果 肿瘤位于膀胱黏膜下,瘤细胞呈巢状或弥漫排列,具有一定异型性,部分为透亮型,部分为小细胞型,靠近边缘的肿瘤细胞呈梭形伴黑色素沉着....     

Locoregional Cutaneous Metastases of Malignant Melanoma and their Management

The correct classification of locoregional metastases of malignant melanoma to skin is central to the planning of treatment. Local recurrence means persistence of neoplastic cells at the local site by virtue of incomplete excision of the primary melanoma. Standard treatment is excisional surgery. In contrast, locoregional metastases of malignant melanoma (satellites, in-transit metastases) are metastases around a primary melanoma or between a primary melanoma and regional lymph nodes. They represent intralymphatic or hematogenous spread of neoplastic cells. We present a variety of available treatment options and discuss especially topical imiquimod as a novel approach for the palliative treatment of locoregional cutaneous melanoma metastases in selected patients.     

Primary malignant melanoma of the bladder

Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.     

A case of metastatic malignant melanoma presenting with hematuria

We report a case of metastatic malignant melanoma that presented with macroscopic hematuria and lower urinary tract symptoms. Effective palliation of urinary tract symptoms was achieved with transurethral resection of metastatic lesions in the bladder. However, the patient was lost due to widespread disease despite systemic therapy. Solitary or multiple dark blue-black nodular or vegetating lesions encountered during cystoscopy should raise the suspicion of metastasis of malignant melanoma and be investigated accordingly.     

Treatment of malignant pheochromocytoma by combination of CVD regimen and transarterial embolization

We performed combination therapy with cyclophosphamide, Vincristine and Dacarbazine (CVD) regimen and transarterial embolization (TAE) in 2 cases of malignant pheochromocytoma with metastases. Case 1: 59-year-old female. After primary left adrenal lesion had been removed, recurrence at the left renal hilar region and metastases to the right iliac bone and 5th cervical vertebra occurred. We took 3 courses of CVD regimen after TAE for the lesions in the right iliac bone. Her endocrinological data has been normal for more than 1 year after treatment. Case 2: 29-year-old male. Total cystectomy, ileal conduit and pelvic lymphadenectomy had been performed for the primary lesion of the urinary bladder. 2 years after the 1st operation, metastases to the right obturator nodes and multiple bones occurred. We gave 3 courses of CVD regimen followed by TAE for the lesions in the right obturator nodes. Just after treatment, we could stop insulin and reduce anti-hypertension drugs, but the effect of treatment was temporary. In conclusion, combination of CVD regimen and TAE is effective for malignant pheochromocytoma with metastases.     

Malignant melanoma of the stomach presenting with an unknown primary lesion

Although the gastrointestinal tract seems to be a common site for melanoma metastases it is extremely unlikely that a melanoma of the gastric mucosa is of primary origin. Only a few cases have been reported in the literature, and the diagnosis is made clinically, endoscopically, or by postmortem material. Moreover, most of these patients have visceral metastases in other areas. A case of malignant melanoma of the stomach diagnosed endoscopically is presented. It was confirmed histologically without any other detectable primary lesion.     

Primary malignant melanoma of the small bowel: a case study.

Malignant melanoma involving the gastrointestinal (GI) tract is diagnosed premortem in only 4 per cent of patients with the disease, even though in autopsy series 60 per cent of patients who died of malignant melanoma have GI metastases. Usually, these GI lesions are metastatic. However, a few cases of primary GI malignant melanoma have been reported. Such a case is reported and discussed, including the clinical presentation, pathophysiology, treatment, and prognosis of this disease.     

阴茎恶性黑色素瘤1例报告并文献复习

目的探讨阴茎原发恶性黑色素瘤的临床诊治及预后。方法对本院1例阴茎原发恶性黑色素瘤的诊疗情况进行回顾性分析。结果患者在本院行阴茎全切加双侧腹股沟淋巴结清扫术。病理证实阴茎浸润性恶性黑色素瘤伴双侧腹股沟多个淋巴结转移。患者术后3月复查时发现有远处转移。结论阴茎原发恶性黑色素瘤临床罕见,确诊依靠病理及免疫组化,手术为主要的治疗手段,但总体预后不佳。     

Hypercalcemia and malignant melanoma.

Malignant melanoma occurs in approximately 1.7 per cent of all patients admitted to the Clinical Center, National Institutes of Health, and approximately 1.8 per cent of patients admitted with hypercalcemia and malignant disease. The incidence of hypercalcemia and malignant melanoma is 1.1 per cent. Bone metastases are diagnosed before death in approximately 5.2 per cent of patients with malignant melanoma. The cause of hypercalcemia in our patients appears to be bone metastases in 83.3 per cent and primary hyperparathyroidism in 16.9 per cent.     

Primary malignant melanoma of the adrenal gland

Primary malignant melanoma of the adrenal gland is an established entity. Fewer than 20 cases have been reported in the published literature. Because of the high frequency of adrenal gland metastases from malignant melanoma and pigmented pheochromocytoma, several rigid diagnostic criteria have been established for accepting an adrenal melanoma as primary. A new case is reported in this article. This observation is an opportunity update the literature on the diagnostic difficulties in this rare pathology.     

原发性膀胱印戒细胞癌1例报告并文献复习

目的：探讨原发性膀胱印戒细胞癌的临床特征。方法：报告1例原发性膀胱印戒细胞癌患者的临床资料。患者因间歇性肉眼血尿就诊,术前检查未找到任何膀胱外病灶,行膀胱全切除术＋输尿管造瘘术。结果：术后病检报告为膀胱印戒细胞癌。患者术后转肿瘤科化疗,目前正在随访中。结论：原发性膀胱SRCC非常罕见,进展快、恶性程度高,局部浸润性生长,有早期扩散转移倾向,预后差。其确诊主要依靠病理组织学检查。     

Multiple brain metastases from malignant melanoma with long-term survival

We present a case of multiple malignant melanoma metastases in the brain who is leading a normal life 16 years after the brain secondaries were managed by surgical resection, stereotactic radiation and chemotherapy. The primary lesion in the left upper arm was excised 4 years prior to the brain metastases. His most recent MRI shows him to be disease free. To the best of our knowledge, this is longest survival reported of any patient with multiple brain metastases from malignant melanoma.     

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.     

Hand metastases from urothelial tumor

Metastases to the hand are rare, particularly those of soft tissues. As a rule they arise in lung, breast, or kidney but other primary sites such as the bladder, have been described. We report a silent primary malignant tumor of the bladder, which came to light as soft tissue hand metastases.     

Multiple synchronous primary malignant tumors of fibrosarcoma and squamous cell carcinoma in the urinary bladder: a case report

A 65-year-old housewife presented with a diagnosis of malignant spindle cell tumor of the bladder which had been diagnosed by work up for chance hematuria. Urine cytology revealed a small number of squamous epithelial cells showing dyskeratosis but no spindle cells. Computed tomography and magnetic resonance images showed a markedly enhanced mass, 4 cm in diameter, on the anterior wall of the urinary bladder, which appeared to be adhesive to the pubic bone. However, no metastasis was found. Under the suspicion of sarcoma of the urinary bladder, we performed anterior pelvic exenteration with construction of an ileal conduit. Although the anterior wall of the urinary bladder was mildly adhesive to the pubic bone, the surgical margin was negative for malignant cells. The tumor corresponded to a fibrosarcoma that infiltrated the adipose tissue surrounding the urinary bladder. The entire mucosa of the bladder showed diffuse squamous metaplasia, and well differentiated squamous cell carcinoma with pearl formation was found in part. These two malignant tumors were clearly apart from each other, resulting in the histologic diagnosis of synchronous multiple malignant tumors of the bladder. The patient developed a local relapse and pulmonary metastasis of fibrosarcoma one month postoperatively and died two month later without any response to chemotherapy (CYVADIC) and radiotherapy. The current case seems to be the first one in Japan (third in the world) of a patient with multiple synchronous primary malignant tumors, carcinoma and sarcoma, airsing in the urinary bladder.     

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.