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Kechagias KS, Zafeiri M, Katsikas Triantafyllidis K, Kyrtsonis G, Geropoulos G, Lyons D, Burney Ellis L, Bowden S, Galani A, Paraskevaidi M, Kyrgiou M. Primary Melanoma of the Cervix Uteri: A Systematic Review and Meta-Analysis of the Reported Cases. Biology 2023; 12:biology12030398. [PMID: 36979090 PMCID: PMC10045237 DOI: 10.3390/biology12030398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer are scarce, we aimed to comprehensively examine the currently available literature and provide an overview of the reported cases of cervical MM focusing on the clinical characteristics, diagnosis and therapeutic management. We conducted a systematic review of the literature by screening three electronic databases until June 2022. The critical appraisal checklist provided by the Joanna Briggs Institute was employed to evaluate the overall quality of the studies. We included 96 reports, which comprised 137 patients diagnosed with MM of the cervix. The mean age of the patients was 56.5 (median: 58, age range: 33–88). Data regarding menopausal status were provided for 98 patients with 15 being premenopausal and 83 being postmenopausal. The most common presenting symptom was vaginal bleeding (83%, 100/121). Biopsy (either excisional or punch biopsy) was used as the first diagnostic modality in most of the patients (67%, 64/95), followed by cytology (18%, 17/95). In 74 cases, the FIGO staging system for cervical cancer was used with the most common stage being FIGO stage I (38%, 28/74), followed by FIGO stage II (36%, 27/74), FIGO stage III (19%, 14/74) and FIGO stage IV (7%, 5/74). Most of the patients were managed surgically (90%, 119/131) with a hysterectomy (either radical or total), and a salpingo-oophorectomy with/without lymphadenectomy was the most common approach utilized (40%, 48/119). The data of clinical outcomes were provided for 105 patients, of whom 61 died (58%, 61/105) and 44 survived (42%, 44/105). Knowledge regarding the rare occurrence of MM in the cervix and the increased awareness of clinicians can prevent clinical misdiagnosis and ultimately improve further the clinical outcomes of patients developing this rare malignancy.
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Affiliation(s)
- Konstantinos S. Kechagias
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Correspondence: ; Tel.: +44-7590803194
| | - Marina Zafeiri
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Konstantinos Katsikas Triantafyllidis
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Nutrition and Dietetics, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Georgios Kyrtsonis
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of General Surgery, Croydon University Hospital, Croydon, London CR7 7YE, UK
| | - Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Deirdre Lyons
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Laura Burney Ellis
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Sarah Bowden
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Apostolia Galani
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Maria Paraskevaidi
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Min A, Fu A, Huang M, Wang H, Chen H. Primary Malignant Melanoma of the Cervix: An Integrated Analysis of Case Reports and Series. Front Oncol 2022; 12:913964. [PMID: 35814437 PMCID: PMC9258497 DOI: 10.3389/fonc.2022.913964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Melanoma, also known as malignant melanoma, is a type of malignant tumour that originates from melanocytes in the basal layer of the epidermis. Primary malignant melanomas of the female genital tract are rare. Similarly, primary malignant melanoma of cervix, which originates from cervical melanocytes, is an extremely rare disease and the second most common type of female melanoma in women aged between 15 to 44 years worldwide. To date, primary malignant melanoma of the cervix is characterized by poor patient prognosis and little consensus exists regarding the best treatment therapy. The situation is worsened by lack of clinical studies with large samples. Notably, surgery remains the preferred treatment option for patients with primary malignant melanomas of the cervix. Current treatments are based on Federation International of Gynecology and Obstetrics(2018) staging with reference to National Comprehensive Cancer Network guidelines. This study is in order to find a more suitable treatment modality for primary malignant melanoma of cervix. Therefore, we first conducted an integrated analysis of case reports and series to assess the impact of various factors on the prognosis of such patients. In summary, this is the first pooled analysis including 149 cases of primary cervical melanoma. We found that patients who underwent radical hysterectomy-based surgery, those with non-metastatic lymph nodes and those who underwent lymphadenectomy had significantly higher survival rates. In patients who had RH-based surgery, survival rates at the 24m time point of those who did not add other treatments was higher than those who did, but for those who had total hysterectomy-based surgery, the addition of other treatments to prolong median survival may be considered. In the overall analysis, age and lymphadenectomy were associated with increased and reduced risk of death in these patients, respectively. Although there is no statistical difference, stage III&IV, TAH, lymphatic metastases increase the risk of death; whereas radical hysterectomy was associated with reduced risk of death. In the subgroup analysis, for patients who have undergone radical hysterectomy-based surgery, lymphadenectomy reduces the risk of death, while lymphatic metastases and complementary other treatments increase the risk of death. For patients who have undergone total hysterectomy-based surgery, complementary treatment reduces the risk of death. In conclusion, via summarizing previous reports, the recommended treatment procedure for PMMC are radical hysterectomy and lymphadenectomy. The addition of other treatment options for patients who undergoing RH-based surgery need further study.
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Affiliation(s)
- Aiping Min
- Department of Obstetrics and Gynecology, People’s Hospital of Leshan, Leshan, China
| | - Aizhen Fu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Meiyuan Huang
- Department of Pathology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Hongjing Wang
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huan Chen
- Department of Obstetrics 1, Zhuzhou Central Hospital, Zhuzhou, China
- *Correspondence: Huan Chen,
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Sun H, Chen Y, Chen Y, Liu D, Yan Z, Bin Meng, Zhao G, Pan Z, Li Q. Primary malignant melanoma of the cervix: 14 cases and literature overview. Melanoma Res 2018; 28:578-85. [DOI: 10.1097/cmr.0000000000000469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Parada D, Peña KB, Riu F. Coexisting malignant melanoma and blue nevus of the uterine cervix: an unusual combination. Case Rep Pathol 2012; 2012:986542. [PMID: 23024873 DOI: 10.1155/2012/986542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/26/2012] [Indexed: 02/03/2023] Open
Abstract
Malignant melanoma (MM) and blue nevi of the uterine cervix are an extremely rare neoplasm, probably derived from embryologic migration of melanocytes from the neural crest. MM displays aggressive behavior with a poor prognosis. We report the case of a 76-year-old postmenopausal woman abnormal vaginal bleeding. She underwent a hysterectomy and bilateral salpingo-oophorectomy with paraaortic-iliac lymphadenectomy. Histopathological and immunohistochemical studies were consistent with the diagnosis of MM and blue nevi in the uterine cervix. Although it is extremely rare, this case suggests that MM of the uterine cervix should be considered in the differential diagnosis of undifferentiated neoplasm. Early diagnosis is essential in order to warrant a better prognosis, although there are no cases of cure described.
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Pusceddu S, Bajetta E, Carcangiu ML, Formisano B, Ducceschi M, Buzzoni R. A literature overview of primary cervical malignant melanoma: an exceedingly rare cancer. Crit Rev Oncol Hematol 2011; 81:185-95. [PMID: 21515070 DOI: 10.1016/j.critrevonc.2011.03.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/03/2011] [Accepted: 03/24/2011] [Indexed: 11/25/2022] Open
Abstract
Primary malignant melanoma (MM) of the uterine cervix is an extremely rare neoplasm, with about 78 cases described in the literature. Since traces of melanocytes in normal cervical epithelium were found in 3.5% of cases primary origin of melanoma at this site cannot be ruled out. It occurs mainly in the sixth decade of life, and it is five time less common than primary vaginal or vulvar MM. Clinical history usually includes abnormal genital bleeding; and physical examination frequently reveals a pigmented, exophytic cervical mass. Diagnosis is confirmed by immuno-histochemical methods and by exclusion of any other primary site of melanoma. Treatment of this condition is not yet standardized, and the overall prognosis is very poor. Diagnostic approaches and therapeutic procedures on primary MM of the uterine cervix are discussed following a review of the literature encompassing more than one century.
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Affiliation(s)
- Sara Pusceddu
- Medical Oncology Unit 2, Department of Pathology, Anatomic Pathology A Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via G. Venezian 1, 20133 Milan, Italy
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Abstract
BACKGROUND Malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. Diagnosis is confirmed by immunohistochemical methods and by exclusion of other primary sites of melanoma. CASE In this paper, we are reporting a case of a 38-year-old patient with a malignant melanoma of the uterine cervix. Diagnosis was made by histological and immunohistochemical method. The tumor was stage IB1 of the International Federation of Gynecology and Obstetrics classification. Chest x-ray and abdominopelvic computed tomography scanning were normal. A radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy was performed. After performing combined radical surgery and irradiation, complete remission of the tumor was achieved. The patient has been followed for 24 months. She is well without any symptoms or signs of recurrence. CONCLUSIONS Malignant melanoma is usually misdiagnosed specially in the chronic form. The immunohistochemical study is useful for definite diagnosis. Treatment is not well established, and the disease histogenesis has been controversial for a long time.
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Abstract
Primary malignant melanoma of uterine cervix is a rare neoplasm. Its diagnosis on cervical fine needle aspiration cytology, a first of its kind in the literature, has been reported. Although cervix is a rare site for melanoma, cytopathologists should be familiar with it and be able to diagnose this entity on cervical cytology when pigment containing tumour cells are present. In a patient with visible growth on cervix, fine needle aspiration cytology may prove to be a useful diagnostic tool, especially when cervical smear/scrape cytology is non-diagnostic.
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Affiliation(s)
- S Gupta
- Division of Cytopathology, Institute of Cytology and Preventive Oncology, New Delhi, India.
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Boldt C, Lehmann R, Osmers R, Bürrig KF. [Primary malignant melanoma of the uterine cervix. Report of two cases and review of the literature]. Pathologe 2003; 24:226-35. [PMID: 12739058 DOI: 10.1007/s00292-002-0596-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The manifestation of a malignant melanoma in the uterus is very rare, more often it is the result of metastasis rather than a primary tumor. A malignant melanoma at this site can originate either from melanocytic elements within the cervical epithelium or from the cervical stroma. We report on two cases of primary malignant melanoma of the uterine cervix and compare them with other cases from the literature.
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Affiliation(s)
- C Boldt
- Institut für Pathologie, Städtisches Krankenhaus Hildesheim GmbH, Hildesheim
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Deshpande AH, Munshi MM. Primary malignant melanoma of the uterine cervix: report of a case diagnosed by cervical scrape cytology and review of the literature. Diagn Cytopathol 2001; 25:108-11. [PMID: 11477714 DOI: 10.1002/dc.2014] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cervical melanoma is a rare neoplasm and is seldom diagnosed by cervical scrape cytology. The possibility of metastatic melanoma should be excluded before making a diagnosis of primary cervical melanoma. We present a case of primary cervical melanoma diagnosed by cervical scrape cytology and a review of literature. The patient presented with vaginal bleeding of 3 mo duration and an ulcerated cervical growth. Cervical smear showed bizarre and abnormal cells containing pigment.
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Affiliation(s)
- A H Deshpande
- Department of Pathology, Government Medical College, Nagpur, India.
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Zamiati S, Sahraoui S, Jabri L, Louahlia S, Sqalli S, Kahlain A. [Primary malignant melanoma of the cervix uteri: apropos of 1 case with review of the literature]. Gynecol Obstet Fertil 2001; 29:381-5. [PMID: 11406935 DOI: 10.1016/s1297-9589(01)00148-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The authors report a case of malignant melanoma of the cervix uteri diagnosed in a young 35-year-old patient. Isolated genital bleeding was the beginning symptom. The physical exam showed a cervical dark tumor, with extension into the vagina (superior third), the parametrium was free. Cervical biopsy concluded to a malignant melanoma. No other abnormalities were observed and the tumor was classed stage IIA-FIGO. A total hysterectomy with bilateral annexectomy and pelvic lymphadenectomy was performed. In the way, the patient died after ten months by local and general recurrence. Primitive malignant melanoma of the cervix uteri is rare. Only 39 cases are reported in literature at this day. It is usually initially misdiagnosed mainly in the achromic forms, then the immuno-histochemical study is useful. Its treatment is not well codified and its histogenesis was controversial for a long time.
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Affiliation(s)
- S Zamiati
- Laboratoire d'anatomie pathologique, CHU Ibn Rochd, quartier des hôpitaux, Casablanca, Maroc
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Furuya M, Shimizu M, Nishihara H, Ito T, Sakuragi N, Ishikura H, Yoshiki T. Clear cell variant of malignant melanoma of the uterine cervix: a case report and review of the literature. Gynecol Oncol 2001; 80:409-12. [PMID: 11263942 DOI: 10.1006/gyno.2000.6091] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A rare variant of malignant melanoma of the uterine cervix mimicking clear cell carcinoma or clear cell sarcoma is described. CASE A 33-year-old Japanese woman was admitted to the hospital complaining of genital discharge and lower back pain. The stage was FIGO IIB and radical hysterectomy and pelvic lymphadenectomy were done. Pathological examination, immunohistochemical studies of melanin granules, and molecular analysis of the EWS/ATF-1 fusion gene were also done. A diffuse proliferation of amelanotic clear cells was detected in the uterine cervix. Tumor cells were positive for HMB 45, Melan-A (MART-1), and S-100 protein and negative for epithelial markers. The EWS/ATF-1 fusion gene was not detected. CONCLUSION This is apparently the first report of a case of clear cell melanoma of the uterine cervix. Despite its rarity, this variant of malignant melanoma should be considered when diagnosing clear cell neoplasms of the uterine cervix.
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Affiliation(s)
- M Furuya
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo 060-8638, Japan
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Abstract
We report the occurrence of a malignant melanoma of the uterine cervix in a patient previously irradiated for a squamous cell carcinoma of the cervix. The management of malignant melanoma of the cervix is reviewed. The risk of second cancers in general, malignant melanoma in particular, after radiotherapy for cervical cancer is also discussed.
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Affiliation(s)
- R J Benson
- Oncology Centre, Addenbrooke's Hospital NHS Trust, Cambridge, UK
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Abstract
Primary malignant melanoma of the cervix was diagnosed in a patient presenting with postmenopausal bleeding. A cervical lesion was biopsied, and diagnosis was established by electron microscopy and staining procedures. After failing radiotherapy, the patient was treated with simple hysterectomy and bilateral salpingo-oophorectomy. The cytology, histology, and electron microscopy of this lesion are presented in addition to a clinical discussion.
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Affiliation(s)
- S B Kristiansen
- John Peter Smith Hospital, Department of Obstetrics and Gynecology, Fort Worth, Texas 76104
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