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  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 422-424
Primary spindle cell melanoma of the urinary bladder


1 Department of Pathology, Cancer Institute, Chennai, Tamil nadu, India
2 Department of Surgical Oncology, Cancer Institute, Chennai, Tamil nadu, India

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Date of Web Publication27-May-2011
 

How to cite this article:
Sundersingh S, Majhi U, Narayanaswamy K, Balasubramanian S. Primary spindle cell melanoma of the urinary bladder. Indian J Pathol Microbiol 2011;54:422-4

How to cite this URL:
Sundersingh S, Majhi U, Narayanaswamy K, Balasubramanian S. Primary spindle cell melanoma of the urinary bladder. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 12];54:422-4. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/422/81612


Sir,

Primary malignant melanoma of the urinary tract accounts for 0.2% of all melanomas. [1] Urinary bladder is a rare site to be primarily involved by malignant melanoma. [2] We report a case of primary spindle cell melanoma of the urinary bladder.

A 56-year-old gentleman complained of difficulty in passing urine and hematuria of 1 month duration. He was detected to have a growth in the bladder and with an initial diagnosis of leiomyosarcoma elsewhere was referred to our institute for management. Cystoscopic examination showed a friable hemorrhagic tumor in the anterior wall of urinary bladder. Cystoscopic biopsy showed transitional epithelium with an underlying tumor composed of fascicles and sheets of oval to fusiform cells [Figure 1]. Tumor cells had moderate cytoplasm and spindle shaped hyperchromatic nuclei with conspicuous nucleoli and more than 10 mitoses per 10 hpf [Figure 2]. Immunohistochemistry showed positive reaction of the tumor cells for vimentin, S100 protein and Melan A [Figure 3] and negative reaction for muscle actin, smooth muscle actin, desmin and HMB-45. There was no history of regressed cutaneous melanoma and dermatologic, gastrointestinal and otorhinolaryngological examinations were negative. A diagnosis of primary amelanotic spindle cell melanoma of the urinary bladder was made. The patient underwent a radical cystectomy with orthotopic ileal neobladder construction. Gross examination showed a polypoidal, necrotic, hemorrhagic tumor involving the anterior and lateral walls of the urinary bladder measuring 9 × 6 × 6 cm. Histopathological examination confirmed the preoperative diagnosis of spindle cell melanoma. The lining transitional epithelium was not involved and no junctional activity was evident. Four months later, the patient developed acute retention of urine. Laparotomy revealed pelvic recurrence, the resection of which showed histologic features similar to that of primary tumor. Six months later the patient died.
Figure 1: Lining transitional epithelium with underlying tumor (H and E, ×100)

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Figure 2: Spindle shaped tumor cells with conspicuous nucleoli and increased mitoses (H and E, ×400)

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Figure 3: Positive reaction of tumor cells for Melan A (Di-amino benzene)

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Melanomas in the urinary bladder are usually metastatic. The criteria for considering a bladder melanoma as primary are absence of cutaneous lesion, no evidence of regressed cutaneous malignant melanoma or other visceral primary melanoma, pattern of recurrence consistent with the region of initial malignant melanoma and presence of atypical melanocytes in the margins of bladder lesion similar to those seen in the periphery of primary mucous membrane lesions.

Spindle cell melanoma is a generic term encompassing desmoplastic and neurotropic forms of melanoma. [3] Desmoplastic melanoma is a rare morphologic subtype of malignant melanoma composed of proliferation of spindle cells with marked desmoplasia. Cellular tumors with very little stroma are referred to as spindle cell melanomas. They are nearly always amelanotic and may cause a diagnostic confusion with other sarcomas and spindle cell carcinoma. Junctional activity may not be demonstrable in spindle cell melanoma. [4]

Immunohistochemistry is important in distinguishing spindle cell melanoma from other sarcomas and carcinoma. Melan A is more sensitive than HMB-45 in identifying the melanocytic origin in spindle cell melanoma. [5] Spindle cell melanoma shows strong and diffuse immunoreactivity for S-100 P. Approximately 50% of these tumors are positive for HMB-45.

Spindle cell melanomas have an aggressive biologic behavior. Since majority of patients present with a locally advanced melanoma of bladder, the prognosis is poor despite the availability of several therapeutic options like partial or total cystectomy, radiotherapy, chemotherapy or immunotherapy.

 
   References Top

1.Pacella M, Gallo F, Gastaldi C, Ambruosi C, Carmignani G. Primary malignant melanoma of the bladder. Int J Urol 2006;13:635-7.   Back to cited text no. 1
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2.Dasgupta T, Grabstald H. Melanoma of the genitourinary tract. J Urol 1965;93:607-14.   Back to cited text no. 2
[PUBMED]    
3.Prieto VG, Woodruff JM. Expression of HMB45 antigen in spindle cell melanoma. J Cutan Pathol 1999;24:580-1.   Back to cited text no. 3
    
4.Longacre TA, Egbert BM, Rouse RV. Desmoplastic and spindle-cell malignant melanoma. An immunohistochemical study. Am J Surg Pathol 1996;20:1489-500.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Busam KJ, Chen YT, Old LJ, Stockert E, Iversen K, Coplan KA, et al. Expression of melan-A (MART1) in benign melanocytic nevi and primary cutaneous malignant melanoma. Am J Surg Pathol 1998;22:976-82.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Shirley Sundersingh
New No. 23, Jambulingam Street, Nungambakkam, Chennai - 600 034
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81612

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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