Author/Authors :
Diakosavvas, Michail Department of Obstetrics and Gynecology - National and Kapodistrian University of Athens, Greece , Fasoulakis, Zacharias N. Department of Obstetrics and Gynecology - National and Kapodistrian University of Athens, Greece , Theodora, Marianna Department of Obstetrics and Gynecology - National and Kapodistrian University of Athens, Greece , Inagamova, Lola Department of Obstetrics and Gynecology - National and Kapodistrian University of Athens, Greece , Kouroupi, Maria Department of Pathology - Democritus University of Thrace, Greece , Giatromanolaki, Alexandra Department of Pathology - Democritus University of Thrace, Greece , Tsatsaris, Georgios Department of Obstetrics and Gynecology - Democritus University of Thrace, Greece , Kontomanolis, Emmanuel N. Department of Obstetrics and Gynecology - Democritus University of Thrace, Greece , Nikolaou, Panagiotis Department of Obstetrics and Gynecology - Democritus University of Thrace, Greece , Frangia-Tsivou, Konstantina HISTOBIO Diagnosis - Athens, Greece
Abstract :
Gynecologic melanomas are extremely rare malignancies, and primary malignant melanoma of the cervix (PMMC) isthe rarest among them all, with less than 100 cases reported so far. Although some conditions have been correlated with thepathogenesis of this entity, no specific risk factor has been yet identified, with vaginal bleeding being the most commonsymptoms. The diagnosis is based on physical examination with speculum assessment and cytologic and histopathologicfindings accompanied with immunohistochemical staining of lesion’s biopsies.Case Presentation. We report a case of PMMC ina 34-year-old para-2 patient, among the youngest cases of PMMC reported, that presented to our clinic for routine examination.Gynecologic examination demonstrated a dark, heavily fully pigmented cervical growth completely covering the entire externalcervical os. Biopsy obtained and showed malignant melanoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The pathological diagnosis was FIGO stage IB1 PMMC. Despite 2 courses of anti-PD-1 antibody (Nivolumab) treatment, the patient passed away 13 months after diagnosis (12 months after surgery).Conclusions. Early diagnosis and subsequently early treatment are of high importance regarding patients’prognosis and survival.No standardized protocols or treatment guidelines specific for this rare cancer have been issued; thus, clinicians are called toassess each case individually. Current treatment options are based on surgical excision mostly with radical hysterectomy, but inadvanced or recurrent state of the disease, other treatment modalities, such as chemotherapy, radiotherapy, andimmunotherapy, can be employed. Prognosis for these patients is very poor, and survival rate remains extremely low, with themedian OS reported being less than 2 years. Reporting and publishing of such cases are both of paramount importance for thebetter understanding of this uncommon cervical malignancy, and further biological and clinical investigations are required formore suitable and effective therapies to be determined. A new staging system, specific to PMMC, could be of great use for thebetter correlation of the disease’s stage and prognosis of these patients.
