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  Table of Contents    
CASE REPORT  
Year : 2016  |  Volume : 59  |  Issue : 4  |  Page : 532-534
Metastatic malignant melanoma of the urinary bladder: A case report and review of the literature


1 Department of Pathology, Umraniye Education and Research Hospital, Istanbul, Turkey
2 Department of Pathology, The Ministry of Justice Forensic Council of Turkey, Istanbul, Turkey
3 Department of Pathology, Denizli State Hospital, Denizli, Turkey

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Date of Web Publication10-Oct-2016
 

   Abstract 

Metastatic bladder tumors constitute <5% of all bladder tumors and metastatic malignant melanoma of the urinary bladder is very rare. We present a case report of a metastatic malignant melanoma of the urinary bladder. A 70-year-old woman without any apparent significant clinical history was admitted to the Department of Urology for gross hematuria. Microscopic findings of the transurethral resection specimen revealed fascicles, sheets, and diffuse areas composed of oval and fusiform cells with focal pigmentation. Immunohistochemical analysis revealed that the tumor cells were positive for human melanoma black-45, Melan-A, and S100, and negative for pancytokeratin. Subsequently, we contacted the patient and learned that she was admitted to the Department of Ophthalmology for painless and progressive visual field loss 15 years ago. She had been diagnosed with a primary ocular (uveal) melanoma. A detailed patient history coupled with histological and immunohistochemical findings were necessary to make the final diagnosis of metastatic melanoma.

Keywords: Malignant melanoma, metastasis, urinary bladder

How to cite this article:
Topal CS, Kır G, Daş T, Sarbay B, Tosun M&. Metastatic malignant melanoma of the urinary bladder: A case report and review of the literature. Indian J Pathol Microbiol 2016;59:532-4

How to cite this URL:
Topal CS, Kır G, Daş T, Sarbay B, Tosun M&. Metastatic malignant melanoma of the urinary bladder: A case report and review of the literature. Indian J Pathol Microbiol [serial online] 2016 [cited 2019 Jul 15];59:532-4. Available from: http://www.ijpmonline.org/text.asp?2016/59/4/532/191820



   Introduction Top


Metastatic malignant melanoma of urinary bladder has been very rarely reported. We performed a systematic search of Medline and PubMed and found that only 30 cases have been published in the English literature. Herein, we present a case report of a metastatic malignant melanoma of the urinary bladder.


   Case Report Top


A 70-year-old woman was admitted to the Department of Urology for gross hematuria. A computed tomography scan showed a 7 cm × 5 cm, irregular, spiculated, polypoidal mass in the urinary bladder [Figure 1]. The patient underwent cystoscopy and complete transurethral resection (TUR) of the bladder tumor. The total resected specimen weighed 80 g. Histopathological examination of the tumor specimen revealed fascicles, sheets, and diffuse areas composed of oval and fusiform cells with focal pigmentation [Figure 2]. The overlying epithelium was eroded, and there urothelial dysplasia or carcinoma in situ was not observed. Immunohistochemical analysis revealed that tumor cells were positive for human melanoma black-45, Melan-A, and S100, and negative for pancytokeratin [Figure 3] [Figure 4], [Figure 5] and [Figure 6]. Initially, the patients complete history had not been reported, and we did not know whether the diagnosis indicated a primary or metastatic malignant melanoma of urinary bladder. Subsequently, we contacted the patient and learned that she was admitted to the Department of Ophthalmology for painless and progressive visual field loss 15 years ago. She had been diagnosed with a primary ocular (uveal) melanoma. This had no extraocular extension and was managed with enucleation with curative intent. We then made the diagnosis of a metastatic malignant melanoma of the urinary bladder. The patient was treated with TUR and systemic chemotherapy using the Dartmouth regimen, including carmustine, dacarbazine, and cisplatin. She is disease free after 8 months of follow-up.
Figure 1: A computed tomography scan showing a 7 cm × 5 cm, irregular, spicukated, polypoidal mass in the urinary bladder

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Figure 2: The tumor composed of fascicles, sheets, and diffuse areas composed of oval to fusiform cells with focal pigmentation (H and E, ×400)

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Figure 3: Tumor cells were positive for human melanoma black - 45 (×400)

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Figure 4: Tumor cells were positive for Melan A (×400)

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Figure 5: Tumor cells were positive for S100 (×400)

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Figure 6: Tumor cells were negative for pancytokeratin (×400)

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   Discussion Top


Metastatic bladder tumors constitute <5% of all bladder tumors. Metastatic malignant melanoma of the urinary bladder is very rare. Through a systematic search of Medline and PubMed, we found that only 30 cases have been published in the English literature [Table 1]. [1],[2] Clinically evident metastatic melanoma of the bladder has been rarely described, and it typically presents as painless, macroscopic hematuria. A subsequent diagnosis is usually made on the basis of the cystoscopic findings and histopathological features combined with a clinical history of previous melanoma. Metastasis of malignant melanoma may present soon after the diagnosis of the primary lesion or after >15 years. This is only the third reported case in the literature describing a urinary bladder tumor resulting from a primary ocular melanoma that was managed via enucleation. [1],[2] Several treatments have been proposed to deal with metastatic malignant melanoma. TUR, partial cystectomy, radical cystectomy, chemotherapy, and radiation therapy have all been used to treat melanoma of the bladder. [3],[4],[5],[6] Metastatic malignant melanoma has a very poor prognosis, with an overall median survival of 6-7.5 months. [3],[7] Our patient was treated with TUR and systemic chemotherapy using the Dartmouth regimen, including carmustine, dacarbazine, and cisplatin. She is disease free after 8 months of follow-up.
Table 1: Case reports of metastatic melanomas of the urinary bladder

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Melanoma of the bladder is typically a secondary recurrence in patients with widespread metastatic melanoma originating from the skin or visceral tissue. In most cases, a detailed patient history, careful examination of the patient's skin, and evaluation of other visceral primary sites are necessary to determine the primary or metastatic nature of the tumor.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Paterson A, Sut M, Kaul A, Altieri V, Mutch F, Jenish P, et al. Metastatic malignant melanoma of the urinary bladder: Case report and literature review. Cent European J Urol 2012;65:232-4.  Back to cited text no. 1
    
2.
Nair BCJ, Williams NC, Cui C, Summers D, Mastrangelo MJ, Hubosky SG, et al. Conjunctival Melanoma: Bladder and Upper Urinary Tract Metastases. Am S of Clin Oncol 2011;9:216-9.  Back to cited text no. 2
    
3.
Ainsworth AM, Clark WH, Mastrangelo M, Conger KB. Primary malignant melanoma of the urinary bladder. Cancer 1976;37:1928-36.  Back to cited text no. 3
[PUBMED]    
4.
Su CT, Prince CL. Melanoma of the bladder. J Urol 1962;87:365-7.  Back to cited text no. 4
[PUBMED]    
5.
Niederberger CS, Lome LG. Primary malignant melanoma of urinary bladder.Urology 1993;41:72-4.  Back to cited text no. 5
[PUBMED]    
6.
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. 6
[PUBMED]    
7.
Crosby T, Fish R, Coles B, Mason M. Systemic treatments for metastatic cutaneous melanoma. Cochrane Database of Syst Rev 2000;2:001215.  Back to cited text no. 7
    

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Correspondence Address:
Cumhur Selçuk Topal
Department of Pathology, Umraniye Education and Research Hospital, Umraniye, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.191820

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    Figures

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