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Kimura K, Yamamoto T, Tsuchiya J, Yoshida S, Yanai S, Onishi I, Fujii Y, Tateishi U. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol (NY) 2024:10.1007/s00261-024-04435-0. [PMID: 38896251 DOI: 10.1007/s00261-024-04435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
In clinical practice, urethral diseases are not as frequent as conditions affecting other components of the urinary system. Radiological imaging tests, such as retrograde urethrography, CT, MRI, and PET/CT, along with patient history, are crucial for accurately assessing relatively rare urethral lesions. This article aimed to provide a comprehensive overview of urethral lesions, from traumatic changes to neoplasms, and discuss the multimodal imaging findings of various urethral lesions that radiologists should know. To this end, the normal imaging anatomy of the urethra and a step-by-step approach that can be used in clinical practice have been presented to help in the systematic understanding of urethral lesions.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuya Yamamoto
- Department of Diagnostic Imaging, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Yanai
- Department of Radiology, Fraternity Memorial Hospital, Tokyo, Japan
| | - Iichiro Onishi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Wang P, Huang Y, Chen B, Li J, Chen Z, Liu L. Primary malignant melanoma of the urethra: Report of 9 cases in China. Asian J Surg 2024; 47:505-512. [PMID: 37330300 DOI: 10.1016/j.asjsur.2023.05.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Primary urethral melanoma is extremely rare and malignant, and accounts for <1% of all melanoma cases. Here, we aimed to gain more insight into the pathological and follow-up outcomes of patients with this tumor type. METHODS We conducted a retrospective analysis of nine patients who had undergone comprehensive treatment at West China Hospital since 2009. Furthermore, we also performed a questionnaire-based survey to determine the quality of life and health statuses of surviving patients. RESULTS Most participants were women, and their ages ranged between 57 and 78 years (mean age: 64.9 years). Common clinical presentations included pigmentation, moles, and irregular neoplasms in the urethral meatus with or without bleeding. The final diagnosis was based on pathological and immunohistochemical examination results. All patients underwent regular follow-ups after receiving surgical or non-surgical therapy, such as chemotherapy or radiotherapy. DISCUSSION/CONCLUSION Our study revealed that pathological and immunohistochemical tests are crucial for precise diagnosis, especially in asymptomatic patients. Primary malignant urethral melanoma generally has a poor prognosis; therefore, early and accurate diagnosis is imperative. Timely surgical intervention and immunotherapy can help improve patient prognosis. Moreover, an optimistic outlook and family support may augment the clinical management of this disease.
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Affiliation(s)
- Puze Wang
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China
| | - Yin Huang
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China
| | - Bo Chen
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China
| | - Jin Li
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China
| | - Zeyu Chen
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan University, Number 37 Guoxue Road, Chengdu, Sichuan Province, China.
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Morra S, Incesu RB, Scheipner L, Baudo A, Jannello LMI, de Angelis M, Siech C, Goyal JA, Tian Z, Saad F, Califano G, la Rocca R, Capece M, Shariat SF, Ahyai S, Carmignani L, de Cobelli O, Musi G, Tilki D, Briganti A, Chun FKH, Longo N, Karakiewicz PI. Demographics, Clinical Characteristics and Survival Outcomes of Primary Urinary Tract Malignant Melanoma Patients: A Population-Based Analysis. Cancers (Basel) 2023; 15:4498. [PMID: 37760467 PMCID: PMC10527544 DOI: 10.3390/cancers15184498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
All primary urinary tract malignant melanoma (ureter vs. bladder vs. urethra) patients were identified from within the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020. Kaplan-Maier plots depicted the overall survival (OS) rates. Univariable and multivariable Cox regression (MCR) models were fitted to test the differences in overall mortality (OM). In the overall cohort (n = 74), the median OS was 22 months. No statistically significant or clinically meaningful differences were recorded according to sex (female vs. male; p = 0.9) and treatment of the primary (endoscopic vs. surgical; p = 0.6). Conversely, clinically meaningful but not statistically significant (p ≥ 0.05) differences were recorded according to the patient's age at diagnosis (≤80 vs. ≥80 years old; p = 0.2), marital status (married 26 vs. unmarried 16 months; p = 0.2), and SEER stage (localized 31 vs. regional 14 months; p = 0.4), and the type of systemic therapy (exposed 31 vs. not exposed 20 months; p = 0.06). Finally, in univariable and MCR analyses, after adjustment for the SEER stage and type of systemic therapy, tumor origin within the bladder was associated with a three-fold higher OM (Hazard ratio: 3.00; p = 0.004), compared to tumor origin within the urethra. In conclusion, primary urinary tract malignant melanoma patients have poor survival. Specifically, tumor origin within the bladder independently predicted a higher OM, even after adjustment for the SEER stage and systemic therapy status.
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Affiliation(s)
- Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (R.l.R.); (M.C.); (N.L.)
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, Medical University of Graz, 8036 Graz, Austria;
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy;
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Università degli Studi di Milano, 20126 Milan, Italy
| | - Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Division of Experimental Oncology, Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
| | - Jordan A. Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
| | - Gianluigi Califano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (R.l.R.); (M.C.); (N.L.)
| | - Roberto la Rocca
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (R.l.R.); (M.C.); (N.L.)
| | - Marco Capece
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (R.l.R.); (M.C.); (N.L.)
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8036 Graz, Austria;
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy;
- Department of Urology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (R.l.R.); (M.C.); (N.L.)
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (R.-B.I.); (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (Z.T.); (F.S.); (P.I.K.)
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Nguyen Q, Nguyen HT, Bui XT, Bui VQ, Nguyen TD. Primary malignant melanoma of the male urethra: Case report and review of literature. Int J Surg Case Rep 2023; 110:108697. [PMID: 37611396 PMCID: PMC10470298 DOI: 10.1016/j.ijscr.2023.108697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION We report a rare case of primary malignant melanoma with inguinal lymph node metastasis in the male urethra. CASE PRESENTATION A 57-year-old male patient presented with a small tumor on the ventral surface of the penis, which was discovered 5 months ago and did not cause pain or discomfort. In the past month, the patient has developed symptoms of urinary incontinence. MRI and PET/CT scans revealed a primary tumor in the penile urethra, but no metastases were found. The patient underwent partial penectomy surgery and laparoscopic bilateral inguinal lymphadenectomy within one month. The pathological combined with immunohistochemical staining confirmed primary malignant melanoma in the urethra with right inguinal lymph node metastasis. Despite complying with surgical and immunotherapy treatment with Pembrolizumab for 18 cycles, the patient was diagnosed with recurrent cancer in the penile stump after 05 months and he passed away after 18 months. DISCUSSION Urethral melanoma is a rare and highly invasive type of cancer. It was often diagnosed at a late stage because the initial symptoms were not obvious in the lower urinary tract. Additionally, cancer progressed very quickly, making it difficult to treat. CONCLUSION Urethral melanoma, if detected at a late stage with lymph node metastasis, has a significantly poor prognosis irrespective of the treatment method employed. However, to our best knowledge, very few publications can be found on this disease, and the strategic treatment remained unknown.
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Affiliation(s)
- Quang Nguyen
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam; University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.
| | - Huu Thao Nguyen
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Xuan Truong Bui
- Department of Surgery, Hanoi Medical Univerity, Hanoi, Viet Nam
| | - Van Quang Bui
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam; University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
| | - Tien Dung Nguyen
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam; University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
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Mahato A, Jain A, Manoj M, Joshi R. Role of 18 F-FDG PET-CT in Urethral Malignant Melanoma and Analysis of the UK Guidelines on Ano-uro-genital Melanomas. World J Nucl Med 2023; 22:244-247. [PMID: 37854079 PMCID: PMC10581754 DOI: 10.1055/s-0043-1771280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Urethral melanomas are a rare subtype of noncutaneous melanomas. The disease has a tendency to have skip lesions and early metastases as compared with cutaneous melanomas. The role of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography computed tomography (PET-CT) is well established in cases of cutaneous melanomas and is recommended by the National Comprehensive Cancer Network (NCCN) for stage IIB to IV cancer. There are no established guidelines on the management of noncutaneous melanomas; however, a recently published United Kingdom national guideline aims to streamline the management of ano-uro-genital melanomas. The guideline describes a very limited role in the use of 18 F-FDG PET-CT in this case scenario. The tendency to skip lesions, early metastases, involvement of brain parenchyma, and finally the usage of anti-PD-1 medications are key areas where 18 F-FDG PET-CT has shown superiority over CT scan. With this case report, we aim to highlight the strength of 18 F-FDG PET-CT in the management of urethral melanomas, which can be extrapolated to other ano-uro-genital melanomas.
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Affiliation(s)
- Abhishek Mahato
- Department of Nuclear Medicine, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Anurag Jain
- Department of Nuclear Medicine, Command Hospital, Lucknow, Uttar Pradesh, India
| | - M.G. Manoj
- Department of Pathology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Richa Joshi
- Department of Oncosurgery, Command Hospital, Lucknow, Uttar Pradesh, India
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Ni Raghallaigh H, Pineda-Turner A, Mather K, Chetwood A. Melanosis of the urinary bladder. Ann R Coll Surg Engl 2023; 105:386-387. [PMID: 35904334 PMCID: PMC10066638 DOI: 10.1308/rcsann.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/22/2022] Open
Abstract
Melanosis bladder refers to the urothelium of the bladder appearing black and velvety, with microscopic evaluation describing melanin deposition. Risk factors, pathogenesis and clinical implications are unknown because only sporadic cases are reported in the literature, both with and without the presence of urinary tract symptoms or malignancy. We report a case of melanosis bladder in a male patient with voiding urinary symptoms and an untreated hypospadias.
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Affiliation(s)
| | | | - K Mather
- Frimley Health NHS Foundation Trust, UK
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7
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А rare case of primary malignant melanoma of the female urethra. Urol Case Rep 2023; 47:102350. [PMID: 36852131 PMCID: PMC9958274 DOI: 10.1016/j.eucr.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Primary malignant melanoma of the female urethra is an extremely rare disease. Its frequency is only 0.2% of all malignant melanomas. This type of carcinoma is associated with a poor prognosis and short survival due to the early occurrence of metastases and delayed diagnosis. We present a patient with primary malignant melanoma invading the distal urethra, part of the labia minora, and sections of the anterior vaginal wall, where 15 months of overall survival were achieved against the background of the complex treatment.
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Mano R, Hoeh B, DiNatale RG, Sanchez A, Benfante NE, Reznik E, Leitao MM, Shoushtari AN, Goh A, Donat SM, Herr HW, Bochner BH, Dalbagni G, Donahue TF. Urethral Melanoma – Clinical, Pathological and Molecular Characteristics. Bladder Cancer 2022; 8:291-301. [PMID: 36277327 PMCID: PMC9536426 DOI: 10.3233/blc-211633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/30/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Mucosal melanoma involving the urethra is a rare disease with distinct clinical and molecular characteristics and poor outcomes. Our current knowledge is limited by the small number of reports regarding this disease. OBJECTIVE: To describe the clinical, pathological, and molecular characteristics of urethral melanoma. METHODS: We summarized the clinicopathologic data for 31 patients treated for urethral melanoma from 1986–2017 at our institution. Genomic data from our institutional sequencing platform MSK-IMPACT (n = 5) and gene-specific PCR data on BRAF, KIT, and/or NRAS (n = 8) were compared to genomic data of cutaneous melanomas (n = 143), vulvar/vaginal melanomas (n = 24), and primary non-melanoma urethral tumors (n = 5) from our institutional database. RESULTS: Twenty-three patients were diagnosed with localized disease, 7 had regional/nodal involvement and one had metastases. Initial treatment included surgery in 25 patients; seven had multimodal treatment. Median follow-up was 46 months (IQR 33–123). Estimated 5-year cancer-specific survival was 45%. No significant change in survival was observed based on a year of treatment. Primary urethral melanomas showed a higher frequency of TP53 mutations compared to cutaneous (80.0% vs. 18.2%, p = 0.006) and vulvar/vaginal melanomas (80.0 vs. 25.0%, p = 0.04). BRAF mutations were absent in urethral primaries (0% vs. 46% in cutaneous melanoma, p = 0.02). Tumor mutation burden was higher in cutaneous than urethral melanomas (p = 0.04). Urethral melanomas had a higher number of somatic alterations compared to non-melanoma urethral tumors (median 11 vs. 5, p = 0.03). CONCLUSIONS: Our findings support a unique mutational landscape of urethral melanoma compared to cutaneous melanoma. Survival remains poor and is unchanged over the time studied.
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Affiliation(s)
- Roy Mano
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Benedikt Hoeh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Renzo G. DiNatale
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Alejandro Sanchez
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nicole E. Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ed Reznik
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Alvin Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S. Machele Donat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harry W. Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H. Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy F. Donahue
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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DePalo DK, Elleson KM, Carr MJ, Spiess PE, Zager JS. Genitourinary melanoma: An overview for the clinician. Asian J Urol 2022; 9:407-422. [DOI: 10.1016/j.ajur.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
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Huang Y, Wei L, Huang Y, Wen S, Liu T, Duan X, Wang Y, Zhang H, Fan B, Hu B. Identification of distinct genomic features reveals frequent somatic AHNAK and PTEN mutations predominantly in primary malignant melanoma presenting in the ureter. Jpn J Clin Oncol 2022; 52:930-943. [PMID: 35578896 DOI: 10.1093/jjco/hyac061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the ureter is extremely rare. Genetic variants to the increased risk of developing the disease have not yet been investigated. METHODS Tumour mutation profiling for primary malignant melanoma of the ureter was performed by whole-exome sequencing. Immunohistochemistry was performed to verify histopathological features and the variants of predisposing genes and driver mutation genes. Furthermore, we conducted a literature review and Surveillance, Epidemiology and End Result-based study by searching public databases. RESULTS We identified 38 somatic single nucleotide variants and 9 somatic insertions and deletions (INDELs) in tumour specimens. After filtering with the Cancer Gene Census database, seven predisposing genes and two driver mutation genes were identified. Moreover, the immunohistochemical profile showed that tumour cells were positive for Melan-A, melanoma gp100 human melanoma black 45 (HMB45), S100 beta and P53. The expression levels of two driver mutation genes (phosphatase and tensin homolog (PTEN) and desmoyokin (AHNAK) and five predisposing genes (AT-rich interaction domain 1B (ARID1B), catalase, eukaryotic translation initiation factor 4 gamma 3 (EIF4G3), ANK3 and collagen type I) were significantly downregulated in tumour tissues compared to paracancerous tissues. In the literature review and Surveillance, Epidemiology and End Results-based study, patients with primary malignant melanoma of the urinary tract had worse clinical outcomes than patients with primary urothelial carcinoma after 1:2 propensity score matching (P = 0.010). Additionally, Cox multivariate analysis for patients with primary malignant melanoma of the urinary tract indicated that distant metastasis (hazard ratio = 1.185; P = 0.044) was an independent predictor for overall survival, and tumour focality (hazard ratio = 0.602; P = 0.017) and non-surgery (hazard ratio = 0.434; P = 0.003) were independent factors for tumour progression. CONCLUSIONS Our study is the first to provide evidence that the distinct phenotypes of primary malignant melanoma of the ureter may be due to different genetic variations. The prognosis of primary malignant melanoma of the urinary tract was poorer than that of primary urothelial carcinoma of the urinary tract.
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Affiliation(s)
- Yan Huang
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Lai Wei
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Yuanbin Huang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Tianqing Liu
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Xu Duan
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Yutong Wang
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Hongshuo Zhang
- Department of Biochemistry, Institute of Glycobiology, Dalian Medical University, Dalian, Liaoning, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bin Hu
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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11
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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12
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Saleh M, Javadi S, Elsherif S, Patnana M, Sagebiel TL, Torres-Cabala C, Matei J, Bhosale P, Faria SC. Multimodality Imaging and Genetics of Primary Mucosal Melanomas and Response to Treatment. Radiographics 2021; 41:1954-1972. [PMID: 34678102 DOI: 10.1148/rg.2021210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucosal melanomas (MMs) are rare and aggressive tumors that arise from melanocytes in the mucosal tissues that line the respiratory, gastrointestinal, and urogenital tracts. Most MMs occur during the 6th and 7th decades of life. MMs may be asymptomatic but may also cause bleeding, pain, and itching, depending on the site of origin. Because of their asymptomatic or oligosymptomatic nature and the difficulty of visualizing them in some cases, they are often advanced tumors at patient presentation. MM staging varies depending on the site of the primary tumor. A simplified staging system allows classification of clinically localized disease as stage I, regional nodal involvement as stage II, and distant metastasis as stage III. MM differs genetically from its cutaneous counterparts. Common drivers in cutaneous melanoma such as B-raf proto-oncogene serine/threonine kinase (BRAF) have a lower mutation rate in MM, whereas mutations of other genes including the KIT proto-oncogene, receptor tyrosine kinase (KIT) and splicing factor 3b subunit 1 gene (SF3B1) are more common in MM. Complete resection is the best curative option. However, surgical intervention with wide local excision and negative margins may be difficult to attain because of the local anatomy and the extent of disease. In addition, despite aggressive surgical resection, most patients develop local recurrence and metastatic disease. Recent advances in the treatment of melanoma include immunotherapy and targeted therapy. Unfortunately, MMs have a relatively poor prognosis, with an overall 5-year survival rate of 25%. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mohammed Saleh
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sanaz Javadi
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sherif Elsherif
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Madhavi Patnana
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Tara L Sagebiel
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Carlos Torres-Cabala
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Jane Matei
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Priya Bhosale
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Silvana C Faria
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
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13
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Nakra T, Dadhwal R, Nayyar R, Rastogi S, Kakkar A, Sharma MC, Yadav R. Primary urethral small cell melanoma with neuroendocrine differentiation: a case report. J Egypt Natl Canc Inst 2020; 32:40. [PMID: 33043406 DOI: 10.1186/s43046-020-00051-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the female urethra is an exceedingly rare tumor. It represents 0.2% of all malignant melanomas. Divergent differentiation towards non-melanocytic lineages has not been reported in urethral melanoma. CASE PRESENTATION We report a rare case of neuroendocrine differentiation in a large primary small cell malignant melanoma involving the urethra, in a 62-year-old lady, who presented with obstructive urinary symptoms. Clinical and radiological workup revealed a large urethral mass with liver and lymph nodal metastases. A biopsy was performed from the urethral and liver lesions which showed poorly differentiated tumor cells with small cell morphology and presence of melanin pigment. These cells were immunopositive for melanocytic and neuroendocrine markers. Ultrastructural examination showed presence of melanosomes and neurosecretory granules in the tumor cells. CONCLUSIONS Although malignant melanoma with neuroendocrine differentiation is exceptionally rare, it needs to be recognized among the other well-known variants of malignant melanoma.
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Affiliation(s)
- Tripti Nakra
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rohit Dadhwal
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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14
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Acikalin A, Bagir E, Karim S, Bisgin A, Izol V, Erdogan S. Primary melanoma of the urinary tract; Clinicopathologic and molecular review of a case series. Pathol Res Pract 2020; 216:153095. [PMID: 32825962 DOI: 10.1016/j.prp.2020.153095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 01/15/2023]
Abstract
Primary melanoma of the urinary tract is a very rare and aggressive cancer. It accounts for less than 1% of all the melanoma cases, making it difficult to histopathologically diagnose and manage. We present a retrospective case series of eight primary urinary tract melanoma with clinical, pathological, and molecular findings to add more insight to this challenging disease. These cases were evaluated for histopathological, immunohistochemical, and molecular features of melanoma that were most commonly found in the urethra, followed by those in the bladder and ureter. Identification of nested growth patterns and in situ melanocytic components at cell edges are helpful in the histopathological diagnosis of amelanotic or hypomelanotic tumors. Our results indicate that urinary tract melanoma has several molecular traits, such as gene expression patterns. Genetic mutations may be related to metastasis, as well as provide targets for the management programs.
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Affiliation(s)
- Arbil Acikalin
- Cukurova University Medical School, Department of Pathology, 01260, Saricam, Adana, Turkey.
| | - Emine Bagir
- Cukurova University Medical School, Department of Pathology, 01260, Saricam, Adana, Turkey
| | - Savalan Karim
- Cukurova University Medical School, Department of Pathology, 01260, Saricam, Adana, Turkey
| | - Atıl Bisgin
- Cukurova University Medical School, Department of Medical Genetics, 01260, Saricam, Adana, Turkey
| | - Volkan Izol
- Cukurova University Medical School, Department of Urology, 01260, Saricam, Adana, Turkey
| | - Seyda Erdogan
- Cukurova University Medical School, Department of Pathology, 01260, Saricam, Adana, Turkey
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15
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Sun X, Wang X, Yu D, Wang Y, Bi L, Xie D. Primary Female Urethral Malignant Melanoma: A Case Report. Urology 2020; 142:e8-e10. [PMID: 32422157 DOI: 10.1016/j.urology.2020.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Xin Sun
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - Xin Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - DeXin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China.
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - LiangKuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - DongDong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
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16
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Caputo A, Califano A, Fabiano M, Altieri V, Zeppa P, D'Antonio A. Amelanotic Malignant Melanoma of the Male Urethra: A Potential Diagnostic Pitfall. Int J Surg Pathol 2020; 28:510-513. [PMID: 32390487 DOI: 10.1177/1066896920919497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A rare disease in an unusual site can closely mimic a typical presentation of a common disease, sometimes with devastating consequences. We present a case of primary amelanotic malignant melanoma of the urethra in a male, with clinical and histological characteristics that could have led to a mistaken diagnosis of high-grade urothelial carcinoma. Amelanotic mucosal melanoma should be suspected in all cases of high-grade mucosal tumors with practically any appearance (epithelioid, sarcomatoid, anaplastic, mixed). Morphological hints pointing toward melanoma-such as the presence of sparse melanin pigment or melanoma in situ-should be sought, and if absent, an immunohistochemical panel comprising S100 and HMB45 should be performed.
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Affiliation(s)
| | | | | | - Vincenzo Altieri
- University of Salerno, Salerno, Italy.,University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Italy
| | - Pio Zeppa
- University of Salerno, Salerno, Italy.,University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Italy
| | - Antonio D'Antonio
- University of Salerno, Salerno, Italy.,University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Italy
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17
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Zeighami S, Soltani M, Khajeh F, Ariafar A, Jahanabadi Z, Miladpour B, Naghdi-Sede N. Primary amelanotic melanoma of the male urethra: A rare entity and diagnostic challenge. Qatar Med J 2020; 2020:11. [PMID: 32274353 PMCID: PMC7114217 DOI: 10.5339/qmj.2020.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/01/2019] [Indexed: 11/29/2022] Open
Abstract
Malignant melanoma (melanoma) is a tumor of melanocytes that usually presents as cutaneous lesions. While melanoma can infrequently appear as a primary tumor elsewhere in the body, it is extremely rare in the urethra and even rarer as amelanotic malignant melanoma. We report the case of a 66-year-old male who presented with painless gross hematuria and lower urinary tract obstructive symptoms in the recent 2 weeks prior to his visit to our clinic. History and physical examination, including external genital examination, abdominopelvic sonography, and urine culture, were not conclusive. Cystourethroscopy revealed a creamy pink fragile mass located in the anterior proximal urethra that extended to the mid portion. Pathological examination of this lesion confirmed the diagnosis of amelanotic malignant melanoma using immunohistochemistry. Radical cystourethrectomy with ileal conduit was subsequently conducted. Although this tumor is extremely rare, urologists and pathologists should consider malignant melanoma as a diagnosis in patients with urethral tumor because of the likelihood of early metastasis and, consequently, poor prognosis. Complete surgical removal of the tumor and use of effective therapies can improve outcomes in these patients.
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Affiliation(s)
- Shahryar Zeighami
- Uro-oncologist, Assistant Professor, Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammmdreza Soltani
- Urologist, Uro-oncology Fellowship Student, Shiraz University of Medical Sciences, Urology Department, Fasa, Iran
| | - Fatemeh Khajeh
- Pathologist, Professor Assistant, Fasa University of Medical Sciences, Pathology Department, Fasa, Iran
| | - Ali Ariafar
- Uro-oncologist, Professor Assistant, Urology Oncology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Jahanabadi
- Urologist, Professor Assistant, Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnoosh Miladpour
- Clinical Biochemist, Professor Assistant, Fasa University of Medical Sciences, Fasa, Iran
| | - Nima Naghdi-Sede
- Urologist, Uro-oncology Fellowship Student, Shiraz University of Medical Sciences, Urology Department, Shiraz, Iran
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18
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Aoki Y, Soma T, Nakamura Y, Fukui N, Sakai Y, Kageyama Y. Malignant melanoma of the male urethra with increased 5- S-cysteinyldopa: A case report. IJU Case Rep 2019; 2:215-217. [PMID: 32743417 PMCID: PMC7292080 DOI: 10.1002/iju5.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/08/2019] [Indexed: 11/07/2022] Open
Abstract
Introduction We herein present a case of malignant melanoma of the male urethra with an increased serum 5‐S‐cysteinyldopa concentration. Case presentation A 77‐year‐old man visited our hospital complaining dysuria and a dark brown mass protruding from the external urethral meatus. His serum 5‐S‐cysteinyldopa concentration was elevated beyond the upper limit of the reference range. Biopsy of the tumor was performed, and the histological diagnosis was malignant melanoma. He underwent total penectomy, and the serum 5‐S‐cysteinyldopa concentration was normalized. He remained alive without evidence of locoregional recurrence or distant metastases for 6 months after surgery. Conclusion Malignant melanoma of the male urethra is uncommon. The prognosis is favorable if it is detected in its early stages. This case report suggests that measurement of the serum concentration of 5‐S‐cysteinyldopa, a melanin metabolite, is useful for early diagnosis of male urethral melanoma.
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Affiliation(s)
- Yusuke Aoki
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan.,Department of Urology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Takahiko Soma
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan
| | - Yuki Nakamura
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan
| | - Naotaka Fukui
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan
| | - Yasuyuki Sakai
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan
| | - Yukio Kageyama
- Department of Urology Saitama Cancer Center Ina-machi Saitama Japan
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19
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Sali GM, Nair KR, Bindhu MR, Ginil Kumar P, Sanjeevan KV, Thomas A. Primary Malignant Melanoma of Urethra-Our Experience with 2 cases. Indian J Surg Oncol 2019; 10:137-140. [PMID: 30948889 DOI: 10.1007/s13193-018-0862-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/11/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Gaurav Mohan Sali
- 1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
| | - Kannan R Nair
- 1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
| | - M R Bindhu
- 2Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
| | - Pooleri Ginil Kumar
- 1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
| | - Kalavampara V Sanjeevan
- 1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
| | - Appu Thomas
- 1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala 682 041 India
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20
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Hansen MF, Abel I, Clasen-Linde E. Primary malignant melanoma of the urethra in a patient with rheumatoid arthritis treated with methotrexate. BMJ Case Rep 2019; 12:12/4/e228033. [PMID: 30948396 DOI: 10.1136/bcr-2018-228033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report a case of a 79-year-old woman with urinary incontinence who presented at a urogynaecology appointment. Her medical history included rheumatoid arthritis (RA) treated with methotrexate (MXT) for 22 years. A polypoidal lesion was protruding from the meatus urethrae. The histoimmunocytology confirmed a primary superficial spreading malignant melanoma. The tumour was extensively excised, but 8 months later, due to a lymphatic nodal swelling, a positron emission tomography/CT was performed showing a process suspicious of malignant melanoma and multiple distant metastasis. The subsequent treatment was palliative and 1 year later, the patient died. The aetiology of malignant melanomas in the urethra is poorly understood. There is consistent evidence that RA is associated with a number of cancers, but it remains controversial whether this risk is increased with MXT. This case emphasises the importance of gynaecological examination even in patients with only weak symptoms from the pelvic region, especially in patients undergoing immunosuppressive treatment.
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Affiliation(s)
- Margrethe Foss Hansen
- Department of Obstetrics and Gynaecology, Nordssjællands Hospital, Hillerød, Denmark
| | - Ivan Abel
- Department of Obstetrics and Gynaecology, Nordssjællands Hospital, Hillerød, Denmark
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21
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Yang N, Lu J, Lu Y, Guo J, Wang H. Primary malignant melanotic melanoma and hypomelanotic melanoma of the female urethra: case series and a review of the literature in China. Melanoma Res 2019; 29:59-64. [DOI: 10.1097/cmr.0000000000000521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Davuluri M, Long B, Semple S, Villanueva-Siles E, Aboumohamed A. Primary Urethral Melanoma: A Case Report and Literature Review. Urology 2019; 126:1-4. [PMID: 30605694 DOI: 10.1016/j.urology.2018.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
Patients with localized urethral melanoma have a high risk of recurrence and poor disease-specific survival. Multi-disciplinary approach including surgery, radiation therapy, and chemotherapy/immunotherapy is needed to maximize survival. Current research efforts include investigation of novel tyrosine kinases as well as the combination of targeted therapies with immunotherapies in this population. Combinations may provide a synergistic effect to overcome various obstacles to disease response.
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Affiliation(s)
- Meenakshi Davuluri
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Stacia Semple
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Ahmed Aboumohamed
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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23
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Samaan S, Quddus MR, Matoso A. "Man in Istanbul" Lesions of the Urinary Tract (Known Entities in an Unusual Context): Melanoma, Carcinoid Tumors, Epithelioid Angiosarcoma. Surg Pathol Clin 2018; 11:825-836. [PMID: 30447844 DOI: 10.1016/j.path.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Certain tumors are more difficult to recognize when they present in an unusual location. Within the urinary tract, primary melanomas, carcinoid tumors, or epithelioid angiosarcoma could present diagnostic challenges due to their infrequent occurrence. This article emphasizes the clinical and histopathologic features of these entities and their differential diagnoses including the immunophenotype and their prognoses.
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Affiliation(s)
- Sameh Samaan
- Department of Pathology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA
| | - M Ruhul Quddus
- Department of Pathology, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02903, USA
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA; Department of Urology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA.
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Jing H, Wei H, Yuan H, Li Y, Li N, Mu D. Melanotic Xp11 translocation renal cancer: a report of a distinctive case and a review of the literature. Diagn Pathol 2018; 13:51. [PMID: 30103811 PMCID: PMC6090727 DOI: 10.1186/s13000-018-0731-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Melanotic Xp11 translocation renal cancer (TRC) is a newly described exceedingly rare tumor, and its characterization remains controversial. This study aimed to describe a case of distinctive melanotic Xp11 TRC and to elucidate its clinicopathological and molecular genetic features. CASE PRESENTATION A 44-year-old Chinese female presented with a left renal mass. Abdominal ultrasonography and computed tomography (CT) scans revealed a 4.5 cm × 4.0 cm mass in the left kidney. Grossly, the well-demarcated mass was black with moderately firm consistency. Microscopic examination indicated that the tumor was characterized by the presence of nests and cords of polygonal cells with clear and granular eosinophilic cytoplasm, central round to oval nuclei and occasional nucleoli. Intracytoplasmic melanin was observed in approximately 45% of tumor cells. Uniquely, the tumor presented with intranuclear eosinophilic pseudoinclusions and thick-walled stromal blood vessels. IHC showed that tumor cells were diffusely positive for TFE3 and exhibited patchy and weak HMB45 staining. FISH confirmed the presence of TFE3 rearrangement. CONCLUSION This case is the twentieth published case of melanotic Xp11 TRC. Moreover, the present patient had a favorable prognosis given that she was disease free at her 113-month postoperative follow-up. Our case adds to the small body of literature on these exceptionally rare tumors and widens their clinicopathological spectrum.
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Affiliation(s)
- Hongbiao Jing
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, No. 440 Jiyan Road, Jinan, 250117, China
| | - Hong Wei
- The Sixth People Hospital of Jinan City, No. 308 Huiquan Road, Zhangqiu, 250200, China
| | - Hongtu Yuan
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, No. 440 Jiyan Road, Jinan, 250117, China
| | - Yahong Li
- Guangzhou LBP Medical Technology Co., Ltd, No. 11 Nanxiang Third Road, Guangzhou, 510663, China
| | - Ning Li
- The Sixth People Hospital of Jinan City, No. 308 Huiquan Road, Zhangqiu, 250200, China
| | - Dianbin Mu
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, No. 440 Jiyan Road, Jinan, 250117, China.
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Primary malignant melanoma of the urinary bladder: clinical, morphological, and molecular analysis of five cases. Melanoma Res 2018; 26:616-624. [PMID: 27603550 DOI: 10.1097/cmr.0000000000000300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of our study was to evaluate the clinical and morphological features of primary malignant melanomas of the urinary bladder. We obtained information on five such cases from three different institutions. These were three men and two women between 52 and 76 years of age. Three tumors presented with hematuria, one with dysuria, and one was discovered incidentally on imaging studies. All were invasive to muscularis propria on transuretral resections performed for diagnosis. Neoplastic cells showed variable patterns (large cell epithelioid, small cell diffuse, storiform, or mixed) in different tumors. Pigmentation was prominent in all except one case. Each case was labeled diffusely for S-100, HMB-45, and Melan-A. Pan-cytokeratin showed a perinuclear dot-like reaction in two tumors. Three cases showed the BRAF mutation in molecular studies. Two patients were already metastatic at the time of diagnosis. Two patients died, one is alive with disease after 15 months, and two patients are disease free at 1 and 5 years of surveillance.
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Bhutani N, Kajal P, Pawar D. Primary malignant melanoma of the female urethra: Report of a rare neoplasm of the urinary tract. Int J Surg Case Rep 2017; 41:319-322. [PMID: 29132118 PMCID: PMC5684422 DOI: 10.1016/j.ijscr.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Melanoma 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 CASE A 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. DISCUSSION The 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. CONCLUSION Melanoma 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.
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Affiliation(s)
| | - Pradeep Kajal
- Deptt. of Paediatric Surgery, PGIMS, Rohtak, Haryana, India.
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Abstract
OBJECTIVE The purpose of this article is to summarize the epidemiologic characteristics, clinical aspects, and radiologic appearance of as well as the management considerations and differential diagnoses for noncutaneous primary melanomas occurring at specific anatomic sites. Primary ocular, sinonasal, meningeal, biliary, adrenal, alimentary tract, and genitourinary melanomas are highlighted. CONCLUSION Noncutaneous primary melanomas are a complex group of malignancies with biologic findings that are unique when compared with findings for cutaneous melanomas. Each noncutaneous primary melanoma has its own specific diagnostic and management challenges, depending on the anatomic location where they arise.
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Urethral duct invasion in female urethral melanoma. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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29
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Funazumi M, Namiki T, Arima Y, Kato K, Nojima K, Tanaka K, Miura K, Yokozeki H. Increased Infiltration of CD8(+) T Cells by Dacarbazine in a Patient with Mucosal Penile Melanoma Refractory to Nivolumab. Ann Dermatol 2016; 28:486-90. [PMID: 27489432 PMCID: PMC4969479 DOI: 10.5021/ad.2016.28.4.486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 02/19/2016] [Accepted: 02/11/2016] [Indexed: 02/02/2023] Open
Abstract
Primary penile melanomas are rare tumors that represent less than 0.1% of all melanomas. We report a case of a 60-year-old Japanese male with a mucosal penile melanoma and describe an increased CD8+ T cell infiltration in brain after dacarbazine (DTIC) administration. After partial penectomy and left inguinal lymphadenectomy, he developed multiple lung, bone, spleen, brain and skin metastases. He was treated with interferon-β, DTIC and nivolumab. However, the metastases were not reduced in size. Immunohistochemistry showed an increase of CD8+ T cell infiltration and programmed death-ligand 1 (PD-L1) expression after the administration of DTIC, but the expression of programmed cell death protein 1 (PD-1) was negative. We speculate that DTIC exerted immunostimulatory effects, but nivolumab was ineffective due to the negative expression of PD-1 and/or an insufficient infiltration of CD8+ T cells. Although this is only one case, this case report could be the first step to discuss the development of effective therapies against melanoma to take advantage of the increased CD8+ T cell infiltration elicited by chemotherapeutic agents. It would be beneficial to pay more attention to the relationship between DTIC and immune checkpoint modulators.
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Affiliation(s)
- Masato Funazumi
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yumi Arima
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Kato
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Nojima
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Tanaka
- Department of Plastic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Miura
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Vyas R, Thompson CL, Zargar H, Selph J, Gerstenblith MR. Epidemiology of genitourinary melanoma in the United States: 1992 through 2012. J Am Acad Dermatol 2016; 75:144-50. [DOI: 10.1016/j.jaad.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/07/2015] [Accepted: 10/17/2015] [Indexed: 10/21/2022]
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31
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Mikkelsen LH, Larsen AC, von Buchwald C, Drzewiecki KT, Prause JU, Heegaard S. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey. APMIS 2016; 124:475-86. [DOI: 10.1111/apm.12529] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 01/31/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Lauge H. Mikkelsen
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
| | - Ann-Cathrine Larsen
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology; Rigshospitalet; Copenhagen Denmark
| | | | - Jan U. Prause
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
| | - Steffen Heegaard
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
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Sanchez A, Rodríguez D, Allard CB, Bechis SK, Sullivan RJ, Boeke CE, Kuppermann D, Cheng JS, Barrisford GW, Preston MA, Feldman AS. Primary genitourinary melanoma: Epidemiology and disease-specific survival in a large population-based cohort. Urol Oncol 2015; 34:166.e7-14. [PMID: 26739672 DOI: 10.1016/j.urolonc.2015.11.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/07/2015] [Accepted: 11/14/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary genitourinary (GU) melanoma is a rare disease, which is poorly characterized. OBJECTIVE To examine clinical characteristics and survival outcomes of primary GU melanoma among men and women. DESIGN, SETTING, AND PARTICIPANTS Retrospective study using the Surveillance, Epidemiology, and End Results database (1973-2010) was used to identify primary GU melanoma cases by tumor site and histology codes. We examined associations of GU melanoma with demographic, clinical, and pathologic characteristics, as well as disease-specific survival (DSS). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS DSS was calculated using the Kaplan-Meier method. Cox-proportional hazard models were used to calculate hazard ratios and 95% CI for factors associated with worse DSS. RESULTS AND LIMITATIONS A total of 1,586 histologically confirmed cases of primary GU melanoma were identified with a median age of 66.1 years (IQR: 55-80). Incidence of primary GU melanoma was 0.2cases/million among men and 1.80cases/million among women. Overall, 60.1% of patients had localized disease at presentation and 90.5% of patients had cancer-directed surgery. Patients with urothelial melanoma had the worst 5- and 10-year DSS (39% and 29%, respectively). Women with vulvar/vaginal melanoma had worse 5- and 10-year DSS compared to men with penile/scrotal melanoma. In multivariate analysis, decreased survival was associated with increasing age, distant stage, and lymph node involvement. Results are limited by the lack of standardized staging for primary GU melanoma and the retrospective design of our study. CONCLUSIONS Patients with primary GU melanoma present with advanced stage and have a poor prognosis. Women have worse DSS compared to men. DSS is negatively associated with advanced age at diagnosis, higher stage, and lymph node involvement. PATIENT SUMMARY Clinicians and patients must be aware of the poor disease-specific outcomes associated with primary GU melanoma. Most importantly, women fare worse than men and mucosal melanomas have worse outcomes compared to cutaneous melanomas.
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Affiliation(s)
| | - Dayron Rodríguez
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | | | - Seth K Bechis
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Ryan J Sullivan
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Caroline E Boeke
- Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Brigham and Women׳s Hospital, Boston, MA
| | - David Kuppermann
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jed-Sian Cheng
- Cooper University Hospital, Cooper Medical School, Camden, NJ
| | - Glen W Barrisford
- Department of Urology, Kaiser Permanente, Santa Rosa Medical Center, Santa Rosa, CA 95403
| | - Mark A Preston
- Division of Urology, Brigham and Women׳s Hospital, Boston, MA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA.
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DeSimone RA, Hoda RS. Primary malignant melanoma of the urethra detected by urine cytology in a male patient. Diagn Cytopathol 2015; 43:680-2. [PMID: 25694368 DOI: 10.1002/dc.23258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/01/2015] [Accepted: 01/31/2015] [Indexed: 12/16/2023]
Affiliation(s)
- Robert A DeSimone
- Papanicolaou Cytology Laboratory, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Rana S Hoda
- Papanicolaou Cytology Laboratory, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
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Balloon Cell Urethral Melanoma: Differential Diagnosis and Management. Case Rep Obstet Gynecol 2015; 2015:919584. [PMID: 26257971 PMCID: PMC4516829 DOI: 10.1155/2015/919584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/05/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas) that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided.
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35
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Update on primary mucosal melanoma. J Am Acad Dermatol 2014; 71:366-75. [PMID: 24815565 DOI: 10.1016/j.jaad.2014.03.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 12/11/2022]
Abstract
Mucosal melanomas are aggressive cancers of mucosal surfaces with clinical and pathologic characteristics distinct from cutaneous melanomas, warranting different staging systems and treatment approaches. Surgical resection is performed frequently for the primary tumor, although the utility of lymph node surgery and radiation therapy is not established. Therapies targeted against C-KIT activating mutations, identified in many mucosal melanomas, are emerging as promising treatments.
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36
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Primary malignant melanoma of the urethra: a systematic analysis of the current literature. Arch Gynecol Obstet 2013; 289:935-43. [DOI: 10.1007/s00404-013-3130-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
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37
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Surabhi VR, Menias CO, George V, Siegel CL, Prasad SR. Magnetic Resonance Imaging of Female Urethral and Periurethral Disorders. Radiol Clin North Am 2013; 51:941-53. [DOI: 10.1016/j.rcl.2013.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Karaman H, Yeşil Y. Primary melanoma of the male urethra. Turk J Urol 2013; 39:201-3. [PMID: 26328109 DOI: 10.5152/tud.2013.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/19/2012] [Indexed: 11/22/2022]
Abstract
Primary melanomas of the genitourinary tract are rare and have poor prognoses. We report a case of a urethral malignant melanoma of a 63-year-old man. This case was regarded as a primary malignant melanoma of the urethra according to histopathological and immunohistochemical findings. Herein, the case is presented and the relevant literature is reviewed and discussed.
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Affiliation(s)
- Hatice Karaman
- Clinic of Pathology, Education and Research Hospital, Kayseri, Turkey
| | - Yüksel Yeşil
- Clinic of Urology, Education and Research Hospital, Kayseri, Turkey
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39
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Papeš D, Altarac S, Arslani N, Rajković Z, Antabak A, Ćaćić M. Melanoma of the glans penis and urethra. Urology 2013; 83:6-11. [PMID: 23978371 DOI: 10.1016/j.urology.2013.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/25/2013] [Accepted: 07/05/2013] [Indexed: 02/03/2023]
Abstract
Primary melanoma of the glans or male urethra is a rare malignant tumor with high mortality. We searched PubMed and found 129 articles reporting on 220 patients. All articles were case reports or case series. Median patient age was 65 years. Median survival was 28 months, with 5-year survival in approximately 10%. All patients who survived over 5 years had a localized disease (stage I/A) with invasion depth <3-3.5 mm. Wide local excision with sentinel lymph node biopsy is the treatment of choice for patients with localized disease. For advanced disease, the prognosis is poor.
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Affiliation(s)
- Dino Papeš
- Department of Surgery, Zagreb Clinical Hospital Center, Zagreb, Croatia.
| | - Silvio Altarac
- Department of Surgery and Urology, Zabok General Hospital, Zabok, Croatia
| | - Nuhi Arslani
- Department of Surgery, University Clinical Center Maribor, Maribor, Slovenia
| | - Zoran Rajković
- Department of Surgery and Urology, Zabok General Hospital, Zabok, Croatia
| | - Anko Antabak
- Department of Surgery, Zagreb Clinical Hospital Center, Zagreb, Croatia
| | - Marko Ćaćić
- Department of Surgery, Zagreb Clinical Hospital Center, Zagreb, Croatia
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40
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Bandarchi B, Jabbari CA, Vedadi A, Navab R. Molecular biology of normal melanocytes and melanoma cells. J Clin Pathol 2013; 66:644-8. [DOI: 10.1136/jclinpath-2013-201471] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Papeš D, Altarac S. Melanoma of the female urethra. Med Oncol 2012; 30:329. [DOI: 10.1007/s12032-012-0329-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/13/2012] [Indexed: 02/03/2023]
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42
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Cho ST, Song HC, Cho B, Choi WS, Lee WK, Lee YS, Lee YG, Kim KK, Park SH, Kim JW. Primary malignant melanoma of the female urethra. Korean J Urol 2012; 53:206-8. [PMID: 22468218 PMCID: PMC3312071 DOI: 10.4111/kju.2012.53.3.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 05/13/2011] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Sung Tae Cho
- Department of Urology, Hallym University College of Medicine, Seoul, Korea.
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43
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Abstract
Melanoma is a malignant tumor that can affect any area of the anatomical economy. Its appearance in the female urethra is extremely rare, with approximately 121 cases in indexed literature since 1966. The subject to be described is an 86-year-old woman who seeks assessment for intermittent macroscopic hematuria with blood clots of 3 months progression. On physical examination, there are no suspicious lesions detected on the surface of the skin. On external genital examination, it is observed a friable lesion at the level of the urethral meatus, with heterogeneous digitations, dark brown to black, and irregular polycyclic borders. No inguinal adenomegalies were palpated. Cystourethroscopy and biopsy of the lesion confirm the diagnosis. Melanoma of the female urethra is an extremely infrequent pathology. Due to lack of published case reports and the absence of prospective randomized trials on treatment outcomes, treatment must be directed using the same anatomical and surgical criteria for female urethral tumors, adding also the concepts of treatment of mucosal melanoma, even though its prognosis is different from the before mentioned.
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Affiliation(s)
- Juan A Ramos
- Universidad de Carabobo, School of Health Sciences, Venezuela
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44
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Primary malignant melanoma at unusual sites: an institutional experience with review of literature. Melanoma Res 2010; 20:233-9. [DOI: 10.1097/cmr.0b013e328334c39a] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Akbas A, Akman T, Erdem MR, Antar B, Kilicarslan I, Onol SY. Female urethral malignant melanoma with vesical invasion: a case report. Kaohsiung J Med Sci 2010; 26:96-8. [PMID: 20123598 DOI: 10.1016/s1607-551x(10)70014-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a 75-year-old female with a primary urethral malignant melanoma. Amass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4x2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.
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Affiliation(s)
- Alpaslan Akbas
- Department of Urology, Vakif Gureba Training and Research Hospital, Istanbul, Turkey.
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46
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Lee SW, Kim EK, Lee WM, Jo JM, Yoo TK, Kang JY. Primary Malignant Melanoma of the Male Urethra. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.6.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Seung Wook Lee
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji University School of Medicine, Seoul, Korea
| | - Won Mi Lee
- Department of Pathology, Eulji University School of Medicine, Seoul, Korea
| | - Jung Man Jo
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
| | - Jeong Yoon Kang
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
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Comploj E, Palermo S, Trenti E, Lodde M, Mian C, Carella R, Pycha A. Unexpected Long Survival in Primary Malignant Melanoma of the Male Urethra. Case Rep Dermatol 2009; 1:93-99. [PMID: 20652123 PMCID: PMC2895219 DOI: 10.1159/000256663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A case of primary malignant melanoma of the urethra in a 60-year-old male is presented. Despite multiple adverse prognostic factors and against expectations, after a follow-up of 5.5 years he is still alive.
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Affiliation(s)
- Evi Comploj
- Department of Urology, General Hospital of Bolzano, Bolzano, Italy
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Melanotic Xp11 translocation renal cancers: a distinctive neoplasm with overlapping features of PEComa, carcinoma, and melanoma. Am J Surg Pathol 2009; 33:609-19. [PMID: 19065101 DOI: 10.1097/pas.0b013e31818fbdff] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe 2 cases of malignant melanotic epithelioid renal neoplasms bearing TFE3 gene fusions. Both neoplasms occurred in children (an 11-y-old boy and a 12-y-old girl), and presented with disseminated metastatic disease including mediastinal and mesenteric adenopathy. Both neoplasms featured sheets of epithelioid cells with clear to finely granular eosinophilic cytoplasm set in a branching capillary vasculature. The neoplastic cells contained variable amounts of finely brown pigment confirmed to be melanin by histochemical stains. By immunohistochemistry, the neoplastic cells labeled for melanocytic markers HMB45 and Melan A, but not for S100 protein, MiTF, or any epithelial marker (cytokeratins, epithelial membrane antigen), renal tubular marker (CD10, PAX8, PAX2, RCC Marker) or muscle marker (actin, desmin). Both neoplasms demonstrated nuclear labeling for TFE3 protein by immunohistochemistry, and the presence of TFE3 gene fusions was confirmed by TFE3 fluorescence in situ hybridization analysis. These distinctive neoplasms combine morphologic features of perivascular epithelioid cell neoplasms (PEComas), Xp11 translocation carcinoma, and melanoma, though the phenotype most closely approaches PEComa. These neoplasms represent the first documented examples in which TFE3 gene fusions coexist with melanin production, and their identification raises the possibility that TFE3 gene fusions may underlie an aggressive subset of lesions currently classified as PEComa in young patients.
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Primary genitourinary melanoma presenting as voiding dysfunction. Int Urogynecol J 2009; 20:1141-3. [DOI: 10.1007/s00192-009-0817-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 01/22/2009] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The significant increase in cutaneous melanomas over the past 30 years has led to studies resulting in advances in their diagnosis, staging, surgical treatment, and adjuvant therapies. Similar approaches have been investigated in patients with far rarer malignant melanomas of the female genital tract. This review will summarize the current state of knowledge on the incidence, causes, presenting symptoms, prognostic factors, therapeutic approaches, and outcomes, site-by-site, for primary melanomas of the vulva, vagina, urethra, ovary, and the uterine cervix. RECENT FINDINGS Surgery remains the initial treatment of choice for localized melanomas of the female genital tract, with less radical, organ function preserving resections demonstrating similar control rates compared with more radical surgical approaches in vulva and possibly vaginal melanomas. Radiation therapy may play a role in the treatment of patients with close resection margins, regional nodal metastasis, or unresectable tumors. Sentinel lymph node studies, positron emission tomography and computed tomography scans for staging and evaluation of response, and adjuvant chemo or biochemotherapy warrant further investigation. SUMMARY The results of treatment for female genital tract melanomas remain poor. Although surgery remains the initial treatment of choice for localized disease, adjuvant local-regional, and systemic therapies are needed.
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