Indian Journal of Pathology and Microbiology
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Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 575-576
Primary malignant melanoma of the uterine cervix


Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi-110 085, India

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Date of Web Publication1-Oct-2009
 

How to cite this article:
Khurana A, Jalpota Y. Primary malignant melanoma of the uterine cervix. Indian J Pathol Microbiol 2009;52:575-6

How to cite this URL:
Khurana A, Jalpota Y. Primary malignant melanoma of the uterine cervix. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Sep 20];52:575-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/575/56164


We discuss a case of a 58-year-old female who presented with the complaint of post-menopausal bleeding for the last one month prior to presentation. Speculum examination showed a large fungating exophytic mass involving the whole of the cervix along with parametrial thickening. Magnetic resonance imaging (MRI) of the pelvis showed a heterogeneous bulky soft tissue lesion of the cervix measuring 9.1 x 8.6 x 8.5 cm, bulging into the upper one-third of the vaginal fornices. Punch biopsy was reported as poorly differentiated carcinoma. Immunohistochemistry (IHC) was recommended, however it was not performed. The patient was put on Cisplatin-based neoadjuvant chemotherapy. After three chemotherapy cycles, she underwent radical hysterectomy with pelvic lymph node dissection. Gross examination showed a diffuse black-colored solid tumor measuring 5 x 4 x 4 cm involving all four quadrants of the cervix [Figure 1].

Microscopy showed a high-grade tumor comprising diffuse sheets of pleomorphic cells with prominent nucleoli, with many cells showing intracytoplasmic brown pigment [Figure 2] and brisk mitotic activity. The overlying epithelium was ulcerated and no junctional activity was identified in the multiple sections.

The tumor cells were positive for vimentin, S-100, HMB-45 and Melan-A [Figure 3]. Pancytokeratin (pan CK) was negative. An extensive search for a melanotic lesion in skin and other sites was negative; hence a diagnosis of primary melanoma of cervix was made. Three months later, the patient developed fever, altered sensorium and complained of radiating pain in the legs. On investigation, she was found to have azotemia with dyselectrolytemia. Computerized tomography (CT) scan revealed multiple nodular swellings in both the lungs and bilateral pelvis, suggesting an extensive metastatic disease. The patient was discharged on request and no further follow-up was possible.


   Discussion Top


Melanoma of the cervix is a rare and aggressive neoplasm associated with short survival rate. About 60% of the cases already have clinical evidence of tumor beyond the cervix at the time of diagnosis. [1] This neoplasm is characterized by histological demonstration of junctional change in the epithelium. [2] However, in a retrospective analysis of 43 primary cervical melanomas, only 14 cases showed a true intraepithelial component. [3] Similarly, in our case, in spite of multiple sections from the cervix, junctional activity was not identified. In the absence of pigment, the diagnosis may be difficult and can be aided by IHC. IHC, as in the indexed case enables us to make the diagnosis of a rare tumor at a rarer site.

Cervical melanoma is highly aggressive as both local recurrence and widespread metastases usually occur within a short span of a few months to two years of the diagnosis. [4] At present the treatment is not well-codified, which can be indeed attributed to its presentation in advanced stage and associated short survival. Though not curative, currently available modalities include surgery, radiation and chemotherapy. Radical hysterectomy with vaginectomy to obtain negative surgical margins of 2 cm is recommended. [5] Pre- or postoperative chemotherapy has variable results, our case showed moderate regression in the size of the tumor. Despite the low radiation specificity of melanomas, radiotherapy can be indicated when surgery is not complete or not possible. Melanoma should be considered in the differential diagnosis of poorly differentiated tumors of the cervix. The amelanotic variety constitutes about 50% of the mucosal melanomas and must be distinguished from commoner tumors like squamous cell carcinoma.

 
   References Top

1.Teixeira JC, Salina JR, Teixeira LC, Andrade LA. Primary melanoma of the uterine cervix figo stage III B. Sao Paulo Med J 1998;116:1778-80.  Back to cited text no. 1      
2.Wright TC, Ferenczy A, Kurman RJ. Carcinoma and other tumours of the cervix. In: Blaustein's Pathology of the female genital tract. 5 th ed. New York: Springer Verlag; 2002. p. 371.  Back to cited text no. 2      
3.Clark KC, Butz WR, Hapke MR. Primary malignant melanoma of the uterine cervix: case report with world literature review. Int J Gynecol Pathol 1999;18:265-73.  Back to cited text no. 3      
4.Zamiati S, Sahraoui S, Jabri L, Louahlia S, Sqalli S, Kahlain A. Primary malignant melanoma of the cervix uteri: Apropos of 1 case with review of the literature. Gynecol Obstet Fertil 2001;29:381-5.  Back to cited text no. 4      
5.Cantuaria G, Angioli R, Nahmias J, Estape R, Penalver M. Primary malignant melanoma of the uterine cervix: Case report and review of the literature. Gynecol Oncol 1999;75:170-4.  Back to cited text no. 5      

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Correspondence Address:
Anuj Khurana
98 SFS Flats, Phase-4, Ashok Vihar, Delhi -110 052
India
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DOI: 10.4103/0377-4929.56164

PMID: 19805980

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Primary Malignant Melanoma of Uterine Cervix
Sunita Bhargava,N. Mogra,Namita Goyal
The Journal of Obstetrics and Gynecology of India. 2013;
[Pubmed]
2 Primary malignant melanoma of the uterine cervix - Case report and review
Simões, M., Cunha, V., Nabais, H., Riscado, I., Jorge, A.F.
European Journal of Gynaecological Oncology. 2011; 32(4): 448-451
[Pubmed]



 

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