No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
An exophytic lesion of the vagina - Cytological findings
Supplementary resource (1)
ResearchGate has not been able to resolve any citations for this publication.
Primary vaginal malignant melanoma is rare, with < 250 reported cases to date. It accounts, for < 1% of all melanomas in women, < 10% of all female genital tract melanomas, and < 3% of all vaginal malignancies. Its clinical behavior is notoriously more aggressive than that of cutaneous and vulvar melanoma, with a 5-year survival rate ranging from 5% to 25%. Tumor size is the strongest predictor Of Survival, whereas tumor thickness is a weak predictor of survival. A case of F.I.G.O. stage I vaginal melanoma encircling and embracing the entire circumference of the middle third of the vagina is described. Tumor size and thickness were 6 cm and 9 mm, respectively. The patient was treated by wide local excision and pelvic radiotherapy, and to date, I I months after surgery, she is alive and with no evidence of disease. It is concluded that wide local excision followed by pelvic radiotherapy is an appropriate treatment for melanoma confined to the vagina.
This report concerns a very rare case of primary malignant melanoma involving the vagina and cervix uteri occurring in a 45-year-old woman. The clinical, light-microscopic and ultrastructural findings are presented and discussed.
Five cases of primary vaginal melanoma were treated at UCLA Medical Center between 1976 and 1986. Two additional cases of melanoma arising at the junction of the vulva and vagina are presented. One of seven (13%) patients is alive, with a median time to recurrence of 7 months, and median survival of 31 months. Four of five vaginal melanomas were located in the distal vagina, and all were advanced at diagnosis (>3 mm depth). Mean size was 3 cm. Initial therapy was local excision in four patients and radical surgery in three. All patients had suboptimal surgical margins: two vaginal primaries had positive margins after local excision, both recurred vaginally within 5 months. Two patients had margins <1 mm, one died of distant metastases, the other is alive with disease 30 months after radical distal vaginectomy and hemivulvectomy with post-op pelvic radiotherapy. Three patients had melanoma in situ at the surgical margins, and each had pelvic recurrences between 6 and 26 months. Five of seven cases developed local recurrence as the initial site of treatment failure. All five vaginal cases ultimately developed distant disease, but only two patients had distant disease without local-regional recurrence. Chemotherapy and immunotherapy enabled disease stabilization in three patients. The vulvovaginal junction at the introitus is a high risk site for vaginal and vulvar melanoma. Intraoperative management requires assessment of lateral and deep spread of invasive and in situ melanoma.
Four cases of primary malignant melanoma of the vagina are described and discussed with respect to vaginal smears. Two cases treated with radiotherapy began to increase the amount of the melanin pigment during the course of irradiation. Characteristic cytologic features found in the four cases are summarized as follows: a) Distribution of cell 1) Scattering, no tendency of grouping 2) Moderate anisocytosis and anisokaryosis b) Cytoplasm 1) Cyanophilic wispy cytoplasm 2) Indistinct cytoplasmic rim 3) Relatively clear cytoplasm 4) Relatively low N/C ratio c) Melanin pigment 1) In melanoma cells-finely granular and diffusely packed in cytoplasm 2) In histiocytes-coarsely granular and densely packed in cytoplasm d) Nucleus 1) Extremely eccentric nucleus 2) Thin and irregular nuclear membrane 3) Relatively regular chromatin distribution 4) Finely or moderately granular chromatin pattern 5) Prominent nucleolus 6) Giant malignant cells (3-4 nuclei) 7) Intranuclear vacuole (punched out).
A case of malignant melanoma of the vagina is described. Ultrastructural examination of tissue from the neoplasm showed a well-developed protein framework similar in appearance to that seen in the slowly progressive lentigo maligna form of malignant melanoma from the general body skin. The spectrum of malignancy known for most other neoplasms, from slowly and locally recurrent to highly aggressive, seems to be found similarly in vaginal malignant melanoma. The patient was treated with local excisions and followed by cytologic examination; she is without known deep or systemic spread after more than three years.
We retrospectively analyzed clinicopathological findings in 10 cases of primary malignant melanoma of the vagina. The main presenting symptoms were vaginal bleeding, vaginal discharge, and feeling of a mass. The tumors were predominantly located in the lowest one-third and in the anterolateral aspect of the vagina. Patients underwent various surgical procedures, radiation therapy, and chemotherapeutic modalities. The mean survival time and the recurrence time from the time of diagnosis were 15 and 8 months, respectively. The tumors were examined for histological characteristics of cell type, presence of melanin pigment, depth of invasion, vascular invasion, intraepithelial spread, junctional activity, and mitotic count. Of all these histological variables, the mean survival time had a significant correlation to mitotic count (P less than 0.04). We concluded that patients with lower mitotic counts (less than 6 per 10 HPF) had better survival (21 months) compared to patients with mitotic counts greater than 6 per 10 HPF who had a mean survival of only 7 months.
Four cases of malignant melanoma arising in the vagina are described, and the literature related to this unusual tumor is reviewed. The 2-year survival rate is better following radical surgery than after other treatment modalities; however, the 5-year survival rate is unrelated to type of therapy. Radical surgery appears to control local disease, but fails to address systemic spread of the tumor. Therefore, improvement in survival will require effective systemic therapy.
Primary melanoma of the vagina is a rare tumor associated with a poor prognosis. The clinical and pathologic features of 15 patients treated at the University of Michigan Medical Center and Bowman Gray School of Medicine are reviewed. The presenting symptom of bleeding was noted in 80% of the patients. The cumulative 5-year survival was 17.4%. Two patients survived more than 5 years. All melanoma tumors were of the nodular type, 66% were located in the lower one-third of the vagina, and all patients were found to have invasion greater than 3 mm at the time of diagnosis. The majority of recurrences were located in the pelvis, with the lung being the most common metastatic site. Data from the literature were incorporated with these patients' data in a meta-analysis. Tumor thickness (6 mm or less) significantly (P = .015) affected the disease-free interval. Tumor size (less than 3 cm) significantly (P = .024) influenced survival, whereas age, stage, tumor location, and tumor thickness did not. There was no significant difference in survival among patients treated by surgical resection, irradiation, or surgical resection plus irradiation. The type of surgery, whether radical or conservative, also did not influence survival. One patient had a complete response to high-dose irradiation fractions (greater than 400 cGy), and this form of irradiation in conjunction with surgical resection is presented as a treatment option.
Sixteen previously unreported cases of primary vaginal melanoma were studied, 8 from the Memorial Sloan-Kettering Cancer Center (1935 to 1976) and 8 from the Connecticut Tumor Registry (1934 to 1976). In addition, 3 previously reported cases from the former institution are updated. Local control was obtained by means of primary radical surgery in 5 of 7 patients, 3 of whom are known to have subsequently died of disseminated disease. One patient initially treated with radical surgery had a local recurrence with metastasis to a regional node, but has now survived for more than 14 years following a second radical surgical procedure. Eight patients were treated primarily with radiotherapy, and 6 have died with metastatic melanoma; another died following pelvic exenteration for persistent local disease. Only 1 patient showed evidence of transient control after radiotherapy, but this patient had a local recurrence 36 months later and died with metastases. The overall 5-year survival rate for these 19 patients was 21%.
Fifteen patients with primary malignant melanoma of the vulva and two with primary malignant melanoma of the vagina were reviewed. Many patients had advanced tumours and the results of surgical treatment were very poor.
Primary vaginal melanoma is an aggressive and rare gynecological malignancy with < 150 reported cases to date. Historically, patients with this disease have a poor prognosis for all types of treatment. In several studies containing small numbers of patients conservative therapy often has been recommended. Eight patients from our institute with this disease were divided into two groups according to therapy: Group A, radical (4); and Group B, conservative (4). The groups were compared for stage, age, surface area of the lesion, and quality of life. The 2-year survival in Group A (75%) was significantly better than that of group B (0%). There was also found to be an improved survival in patients who had lesions with a surface area < 10 cm2. Age and stage of disease did not affect prognosis. Quality of life was not reduced in the radical group. A review of all reported cases since 1949 (119) was then performed. These were divided into the same Group A, radical (50); and Group B, conservative (69). Again, a statistically significant improved outcome was found with the radically treated patients (48%) when compared to the conservatively treated patients (20%). Our findings suggest that radical surgery for patients with primary vaginal melanoma is recommended in patients with lesions < 10 cm2.
Our purpose was to describe the incidence of vulvar and vaginal melanoma and to evaluate risk factors. We also aimed to provide population-based estimates of survival and to evaluate prognostic factors.
We calculated incidence rates and survival curves based on 15 years' experience of population-based registries that together cover approximately 10% of the United States population.
The incidences of vulvar and vaginal melanoma were 0.108 and 0.026/10(5) per year. White women experienced an increased incidence of vulvar melanoma but not vaginal melanoma (relative risks 2.6 and 1.0 for white women, compared with black women). For vulvar melanoma the 5-year survival was 50%; regional or distant spread, older age, and black race were adverse prognostic factors. For vaginal melanoma the 5-year survival was 19%; black race was an adverse prognostic factor.
Vulvar melanoma and vaginal melanoma differ from nongenital cutaneous melanoma in epidemiologic features, which is consistent with the hypothesized systemic sun-induced melanoma-inhibitory factor and with melanin interference with nonultraviolet carcionogenesis. These population-based data identified prognostic factors and confirmed the poor prognosis of these tumors.
Malignant melanomas of the vulva and vagina are rare tumors located in areas of the body not exposed to ultraviolet radiation. Investigations comprising large consecutive population-based series of patients with these diseases have not been published previously, to the knowledge of the authors.
Trends in incidence, age distribution, and prognosis were investigated among 219 consecutive cases of malignant melanoma of the vulva and 26 cases in the vagina, reported to the Swedish National Cancer Registry and representing virtually all primary tumors of that kind in Sweden during a 25-year period, 1960-1984.
On average, 75% of the patients with vulvar melanoma and 73% with vaginal melanoma were older than 60 years of age. The mean age increased slightly but not significantly during the period. The age-standardized incidence of vulvar melanoma decreased from 0.27 to 0.14 per 100,000 Swedish women, or by 3% per year. The observed 5-year survival rate of patients with vulvar melanoma was 35%, and the relative survival rate was 47%. The observed and relative survival rates at 10 years were 23% and 44%, respectively. Observed and relative survival rates among patients with vaginal melanoma after 5 years were 13% and 18%, respectively.
Accordingly, there was a decreasing incidence of vulvar and vaginal melanoma over the observed 25 years. This is in contrast to the trends in incidence for cutaneous melanomas in Sweden, which, during the same time period, increased almost 6% per year.
Pelvic exenteration has usually been employed as salvage treatment for gynecologic malignancies which have failed primary radiotherapy. The therapeutic mainstay for vulvar melanomas has become wide local excision with or without concurrent regional node dissection. Patients with primary melanoma of the vagina who undergo exenteration as primary therapy may experience 50% 5-year survival if the pelvic nodes are free of metastases. However, the overall 5-year survival for vaginal melanoma is 15%. In our patient population, there have been four patients with vaginal or urethral melanomas treated primarily with pelvic exenteration. The purpose of this study was to report that patients with vaginal or urethral melanomas over 3 mm in thickness may benefit from primary pelvic exenteration. Four patients underwent pelvic exenteration at Indiana University Medical Center for malignant melanoma of the vagina or urethra between 1986 and 1992. The pathologic specimens of all patients were analyzed for thickness, growth pattern, and nodal metastases. Patient age ranged from 50 to 71. Thickness of the melanomas ranged from > 3 to 12 mm. All four patients underwent exenterations, three total and one anterior. All patients had negative pelvic and inguinal nodes at the time of surgery. None of the patients has experienced a recurrence. Three of four patients are alive without evidence of disease at 31 to 97 months following their exenteration. One patient died postoperatively of cardiopulmonary complications. Patients with melanomas of the vagina and female urethra, greater than 3 mm in thickness, may benefit from primary pelvic exenteration.
To document the incidence and trends of oronasal melanoma with time, place, and person and to provide population-based estimates of survival and prognostic factors.
Descriptive analysis of 9 population-based cancer registries in the United States for the years 1973 to 1991.
All patients with primary melanoma of the oronasal mucosa who resided in the registry areas, which included approximately 10% of the US population.
None.
The incidence of oronasal melanoma was 0.041/10(5) per year. There were no significant race or gender differences in incidence. Melanomas of the nasal cavity were more common in the northern registry areas, and increased in incidence during the 19-year study period. Oral melanomas were less common in the North, and did not change significantly in incidence. The median survival with oronasal melanoma was 2 years, and the 5-year survival (+/- SE) was 25% (+/- 4%). Advanced age and stage were adverse prognostic features, but no significant differences in the prognosis were noted by anatomic subsite.
We have documented the incidence and prognosis of oronasal melanoma based on a large population-based sample. The prognosis is poor. The epidemiologic features differ substantially from those of cutaneous melanoma.
We present a case report of a woman who has survived 13 years after conservative treatment with wide excision for vaginal melanoma and review and evaluate the literature on this disease since the last metaanalysis in 1989.
A database literature search along with cross referencing from related articles uncovered 66 patients who were reported to have vaginal melanoma since 1989 with adequate information for our analysis. We add to this one original case reported by us. Where information was available, we analyzed outcomes on these cases on the basis of patient age, tumor thickness, tumor size, and treatment.
The patient we describe is only the eighteenth reported patient to survive vaginal melanoma 5 years and only the third to survive for 10 years. Of the 67 patients in our overall review, mean age at the time of diagnosis was 62 years. Patients with tumor size < 3 cm had a mean survival of 41 months compared with 12 months for those with tumor size > or = 3 cm (p < 0.0024). Tumor thickness did not significantly affect patient survival at any of the depths analyzed, although there was a tendency toward significance at depths > 8 mm (p < 0.0778). There also was no significant difference in patient outcome among five treatment groups: (1) wide excision, (2) radical surgery, (3) radiation therapy, (4) wide excision plus radiation therapy, and (5) other.
Tumor size appears to affect survival in patients with vaginal melanoma. Tumor thickness, at least at the levels at which vaginal melanomas are currently being diagnosed, does not seem to affect survival. Because no single treatment is clearly preferable, we suggest conservative resection where possible. We find it difficult to support radical surgery as primary treatment for vaginal melanoma unless necessary to achieve clear tumor margins. Radiation therapy appears to offer results comparable to those of surgery.
We report an 84-year-old Japanese woman who presented with a pedunculated malignant melanoma of the vaginal mucosa. Mucosal melanoma is believed to be more common in Japan than other countries, but such tumors of the vulvovaginal region are quite unusual. In our patient, three tumors were connected by a narrow pedicle. Three black tumors measuring 5-10 mm in diameter with a common pedicle were seen on the vaginal mucosa at five o'clock from the cervix. The tumors were hanging from the narrow pedicle. On histologic examination, they were diagnosed as malignant melanoma. Resection was done with a distal margin of 3 cm from the tumors and a margin of 1 cm from the cervix. The patient has had no evidence of local recurrence or distant metastasis. In our patient, the three main tumors had a common pedicle, which seems to be a unique finding. Since pedunculated malignant melanomas are rare, making a clinical diagnosis is difficult. Although pedunculated melanomas are recognized as having a high malignant potential because these lesions are generally thick, a relatively good outcome is sometimes reported. In our patient, there was no tumor infiltration into the dermis of the pedicle, and this may be one reason for the good outcome at present. There has been no previous report of a mucosal melanoma consisting of three tumors like those in the present patient.
Primary vaginal malignant melanoma is rare, with < 250 reported cases to date. It accounts for < 1% of all melanomas in women, < 10% of all female genital tract melanomas, and < 3% of all vaginal malignancies. Its clinical behavior is notoriously more aggressive than that of cutaneous and vulvar melanoma, with a 5-year survival rate ranging from 5% to 25%. Tumor size is the strongest predictor of survival, whereas tumor thickness is a weak predictor of survival. A case of F.I.G.O. stage I vaginal melanoma encircling and embracing the entire circumference of the middle third of the vagina is described. Tumor size and thickness were 6 cm and 9 mm, respectively. The patient was treated by wide local excision and pelvic radiotherapy, and to date, 11 months after surgery, she is alive and with no evidence of disease. It is concluded that wide local excision followed by pelvic radiotherapy is an appropriate treatment for melanoma confined to the vagina.
This is a retrospective analysis of malignant melanoma of the female genital tract, focusing on the high local recurrence rate of this tumor.
All women treated for malignant melanoma of the genital tract were identified through the archives of the Hadassah University Hospital. The medical records and the pathological specimens were reviewed and reevaluated.
From 1986 to 2002, nine cases were diagnosed and treated at Hadassah. Seven had vulvar melanoma and two had vaginal melanoma. Sixty-six percent (6/9) of the patients had more than one focus of melanoma, either apparent at their initial diagnosis (3/9) or developed during follow up (3/9). Most of the recurring lesions were melanoma in situ. In one patient multiple nodular melanomas were detected. Atypical melanocytic hyperplasia was found in an otherwise normal mucosa in four patients. Three had experienced multiple recurrences. All patients were treated by radical local excisions with (3/9) or without (6/9) elective groin lymph node dissection. Three patients with locally recurring melanoma within the genital tract required two to five sessions of repeated surgical excisions.
It is suggested that melanoma of the genital tract is the result of a multifocal disorder of the melanocytes within the mucosa. The increased local recurrence rate reflects an inherent abnormality of melanocytes. It is not attributed to surgical failure in controlling the disease. Insistent and even radical surgical excision is recommended, especially for patients whose prospects for prolonged survival are improved.
The cytologic findings of malignant melanoma of the vaginal wall
- Aschitaka Y
Aschitaka Y, Taki I, Yanagida T. The cytologic findings of
malignant melanoma of the vaginal wall. J Jap Soc Clin
Cytol 1963; 4: 27.
Melanoblasts in vaginal mucosa
- Nigogosyan