REPORT Malignant melanoma of the vagina S.N. Shaht KEY WORDS : vagina,nodule,melanoma ABSTRACT Primary malignant melanoma of the vagina is a very rare but very aggressive tumor.A 60 year old woman was admitted to the gynaee ward with chief complain of vaginal discharge.On vaginal examination a single blackish colored nod histopathological examination. It was diagnos jule was observed.It was excised and sent for ed as Malignant Melanoma which was confirmed by immunohistochemistry.The case is reported with a brief review of literature. INTRODUCTION Primary melanoma of the vagina is a rare tumor associated with a poor Prognosis.(1) It presents as a soft polypoid mass,blue or black,frequently ulcerated.(2) It accounts for <1% of all melanoma in woman,<10% of all female genital tract melanomas and <3% of all vaginal malignancies.(3) Most case are located in the lower one third and in the anterolateralaspect.(4) The melanocytes that have been identified in 3% of normal vagina most likely represent the cell of origin of this neoplasm.(6) ‘The natural history of vaginal malignant melanoma differs from that of the skin with a more aggressive behavior.(6) CASE REPORT ‘A 60 year old woman was admitted to the gynace ward with chief complain of discharge per vagina.She had menopause since 6 years.On examination there was a brownish black nodular mass soft to firm in consistency and about 3 em diameter at the junction of middle and lower third of posterior vagina.The biopsy from vaginal nodule was taken and sent for hisopathological examination. Gross findings : On gross examination 2 tissue bits were received.The bigger was 1x1 em in size brownish black in color and smaller one was 0.3 em size tissue bit blackish in color.Both bits looked like clotted blood. Microscopic findings : H &E stained sections showed lining stratified squamous epithelium showing mild dysplasia beneath which there was acellular mass ‘The cells were polyhedral or spindly with large hyperchromatic nuclei and heavy melanin pigmentation in the eytoplasm.The cells were arranged in diffuse sheets and were highly pleomorphic. The histopathological findings were suggestive of malignant melanoma. The tissue was sent for immunohistochemistry where S-100 positivity was seen which confirmed the diagnosis. DISCUSSION The primary malignant melanoma of the vagina is a very rare tumor with less than 300 cases reported worldwide.’In one study, 73% of cases of vaginal melanoma were older than 60 years of age.(S) In 1980,Chung et al cited 81 published cases.The neoplasm was observed in women ranging from 37 to 72 years of age.(9) Our patient was of 60 years age The presenting symptoms included vaginal bleeding,vaginal discharge,pelvic pain and a pelvic mass.(9) The lower vagina was the most common, site of origin-both anterior and posterior vaginal wall.(10) In one study of 10 cases, the tumor was predominently located in the anterolateral aspect of lower one third of vagina.‘In our case the tumor was located in lower one third posterior vagina and the presenting complain was vaginal discharge. Correspondence address : Dr. Shaila N. Shah 1, Kalpdroom Flats, Nr. Takhteshwer Post Office, Waghawadi road, Bhavnagar. E-mail drshaila@sancharon line.net a cusanar CAL JOURNAL /PEBRUARY-2010 (b1.65 Yo.sheets of with showing spindly hyperchromatic nuclei and showing pigment in the eytoplasm..(H & E x 400). To be kept near microscopic findings. Fig.1. Photomicrograph polyhedral or cells The lesions varied in size.The smallest reported by Chung et al was 0.5 cm in diameter whereas the largest involved the entire anterior vaginal wall.(9) Primary vaginal malignant melanomas are mostly of the nodular type and tend to show lateral junctional spread and to be composed of anaplastic pleomorphic cells.(11) An intraepithelial component of lentiginous appearance(junctional activity) should be looked for to substantiate local origin.(2) Malignat melanoma localized in the vagina results from the malignant transformation of an ectopic melanocyte during menopause.(12) Histopathologically the neoplastic cells are either epithelioid or spindled.(13) Immunohisto~ chemically $-100 protein was strongly and diffusely positive in 25 of 26 cases.(96%)..8-100 remains the most sensitive marker for these tumors.(13) Vaginal melanomas have a poor prognosis. The crude 5 year survival rate was page 5 21% in the series reported by Chung et al.(8) Melanomas with a mitotic count of less than 6 mitotic figures per 10 high power field s have a better prognosis than those with higher rates.(2) Thus mitotic count is inversely proportional to survival but vascular invasion and depth of invasion do not correlate with survival,Tumor size is the strongest predictor of survival whereas tumor thickness is a weak predictor of survival.(2) In conclusion the case is reported because of its rarity and an attempt is made to describe its pathological and clinical features. 10. in 12, REFERENCES, Baumann D,Bohme M.LenzE,TheuringU.Rare site of ‘malignant melanoma.Zentribi Gynakol. 1992:114(12) 609-12 Juan Rosai. Rosai and Ackerman's Surgical Pathologs:9 edition New Delhi. Elsevier. 2004:1508-1517, Piura B,Rabinovieh A,Yanai-Inabarl,Primary malignant ‘melanoma of the vagina‘case report and review of literature.Bur J Gynaecol Oncol 2002:28(3):195'8, Borazjani G,Prom KA,Okagaki T, Twiggs LB,Adeock LL.Primary ‘malignant melanoma of the vagina‘a clinicopathological analysis of 10 cases.Gynecol oncol.1990: 87(2):264-7 [Nigogosyan G,DeLa Pava 8,Pickran JWMelanoblasts in the vaginal mucosa.Origin for malignant melanoma. Cancer1964:17:912'913, Cobellis L,Calabrese B,Stefanon B,RaspaglieaiF, Malignant melanoma of the vagina.A Report of 15 cases. Hur J Gynaecol Oncol 2000:21(80:295°7. Betschart C,Von Orellis,Mihic D,Fink D.Primary malignant melanoma of the vagina-Case report and review of the literature.Gynakol Geburtshifliche Rundsch 2007:47(): 37-44. Ragmarsson-Olding B,Johansson H,Rutquist LE,Ringborg U.Malignant melanoma of the vulva and vagina.Trends in incidence,age distribution and long term survival among 245 consecutive cases in Sweden. Cancer 98:7 1(5):1899-7 Chung ARCasey MJ,Flannery JT et al-Malignant melanoma of the vagina‘Report of 19 cases, Obstet Gynecol 1980%55:720-727. Liu L,Lis,Hong W.Primary malignant melanoma of the vagina al report of 22 cases.Page 7 Zhonghua Zhong Lin Za Zhi.1996:18(5):385°7, J.L.Burton.M.Wells.Tumors of the vagina In:Christopher D.MFletcher- Diagnostic histopathology of tumors.2°* ed.China!Churchill Livingstone,2008'705-713. Leveque J.Meunier B,Poulain P et al.Malignant melanoma of the vagina.Two case reporta.Review of the literature.J Gynecol Obstet Biol Reprod 1995:24(3):268-72, Gupta D,Malpiea A.Deavers MT,Silva EG.Vaginal melanomaia clinicopathologic and| Immunochemical study of 26 cases.Am J Surg Pathol 2002:26(11):1450°7, Every possible care is taken in publishing the News Bulletin, however any omission / error is purely unintentional & accidental LM.A. G.S.B. does not guarantee directly or indirectly for the quality or efficiency of any products or services described in advertisements in this issue (78)