Primary malignant melanoma of the cervix: a rare disease

Abstract

Malignant melanoma (MM) arising primarily in the cervix is exceedingly rare and has a poor prognosis. We report the case of a primary MM of the cervix in a 64-year-old woman with vaginal bleeding. She presented with a cervical amelanotic lesion which on biopsy rendered the diagnosis of MM. The patient was staged as International Federation of Gynecology and Obstetrics IIB and underwent Wertheim-Meigshysterectomy followed by brachytherapy. One year later, she was diagnosed with a large pelvic relapse for which surgery was performed. She then presented with a vaginal relapse and an isolated hepatic lesion, both of which were proposed for surgery. The diagnosis of MM of the cervix is a clinical and pathological challenge due to its rarity and overlapping features. Cytology cannot accurately diagnose it. Moreover, amelanotic MMs must be distinguished from other poorly differentiated carcinomas by diagnosis that ultimately relies on immunohistochemical staining. Radical surgery is the only treatment showing predictive benefit.

Figure 1

Colposcopy assessments in October 2014.

Figure 2

Colposcopy assessments in January 2015.

Figure 3

Colposcopy assessments in January 2015, 18 days after figure 2.

Figure 4

Microscopic examination showed a highly cellular neoplasm exhibiting a high mitotic activity (H&E).

Figure 5

Immunohistochemistry: the tumour cells were positive for HMB45.

Figure 6

Immunohistochemistry: the tumour cells were positive for Melan-A.

Figure 7

Immunohistochemistry: the tumour cells were positive for S100 protein.

Figure 8

Gross examination of the surgical specimen showing a polypoid pale lesion in the posterior quadrants of the cervix.