Carbon ion radiotherapy with complete tumor regression for primary malignant melanoma of female urethra orifice: a case report

Primary malignant melanoma of the female urethra (PMMFU) is extremely rare, accounting for 0.2% of all melanomas, and fewer than 200 cases have been reported worldwide. Because of the small number of clinical cases and unclear biological characteristics, there is no uniform and standard treatment protocol. We herein describe the treatment of PMMFU using carbon ion radiotherapy. The radiotherapy was delivered at 60.8 Gy (RBE) in 16 fractions, once daily, five times per week. The patient achieved complete tumor disappearance within 1 year after carbon ion radiotherapy and remained disease-free thereafter. She developed acute grade 1 radiation dermatitis and urethritis, which resolved quickly; no other toxic effects were observed. At the time of this writing, her survival duration was 33 months. This case demonstrates that carbon ion radiotherapy may be a good option for primary genitourinary mucosal malignancies.

A case of primary malignant melanoma of the esophagogastric junction with abscopal effect after nivolumab administration

Background The abscopal effect is a rare phenomenon in which local irradiation causes tumor regression outside the irradiated area. There have been no reports of abscopal effect in patients with gastrointestinal melanoma with metastasis. Here, we report a case of primary malignant melanoma of the esophagogastric junction with abscopal effect after long-term treatment with nivolumab. Case presentation A 75-year-old woman was referred to our hospital with a gastroesophageal lesion. Upper gastrointestinal endoscopy revealed a raised lesion on the posterior wall of the greater curvature of the cardia and tenderness in the lower esophagus. Immunostaining of the tumor biopsy showed positive staining for Melan-A, human melanoma black-45 (HMB45), and S-100, indicating malignant melanoma of the esophagogastric junction. Contrast-enhanced computed tomography (CT) of the abdomen showed a mildly stained lesion protruding into the cardiac part of stomach and enlarged surrounding lymph nodes. The patient was diagnosed with malignant melanoma of the esophagogastric junction and proximal gastrectomy with lower esophagus resection was performed. Histological examination showed large, round tumor cells with nuclear atypia. Immunostaining was positive for Melan A, HMB45, S-100 protein, and SRY-box transcription factor 10, and the final diagnosis was malignant melanoma of the esophagogastric junction, with regional lymph node metastases. Three months after surgery, follow-up CT indicated left pleural metastasis; therefore, the patient was administered nivolumab, an immune checkpoint inhibitor (ICI). Following three courses of nivolumab, the patient exhibited grade 3 renal dysfunction (Common Terminology Criteria for Adverse Events version 5.0). After that, we have not administered nivolumab treatment. Five months after the development of renal dysfunction, a CT scan demonstrated an unstained nodule within the pancreatic, and the patient was diagnosed with pancreatic metastasis; intensity-modulated radiotherapy was performed. Six months later, CT revealed pancreatic nodule and pleural metastasis was shrunk; after an additional 2 months, pleural metastasis and effusion had disappeared. The patient is alive with no additional lesions. Conclusions We report a case of primary malignant melanoma of the esophagogastric junction with an abscopal effect following nivolumab treatment. The findings of this case report suggest that ICIs in combination with radiotherapy may be effective for treating metastatic or recurrent malignant melanoma of the gastrointestinal tract.

Melanomas malignos do rebordo alveolar na maxila: apresentação de um caso

A case of primary malignant melanoma on the upper alveolar ridge is reported in a thirsty six year old white woman. A partiar prohthetic denture acted probably as an irritative agent producing prechange of color of alveolor mucosa. Radiumtherapy was done as a palliative treatment. The death due to general metastasis occurred in les e than one yeer. The surgical treatment should be done preferently.

A case of primary malignant melanoma of the red border of the lower lip

According to the literature, the localization of primary melanoma on the lips is rare. Here is our observation.

Primary Malignant Melanoma of Vagina: A Clinicopathologic Analysis of 6 Cases

Introduction/Objective Primary malignant melanoma of vagina (PMMV) has a very high rate of recurrence and poor long-term survival. Less than 250 cases are reported in English literature to date, optimal treatments, risk factors, and prognostic predictors for PMMV are still subjects of debate. This study sought to evaluate the clinicopathologic features, initial management, and survival of 6 patients over 7 years follow-up in one institution. Methods/Case Report In this study, the clinical and pathologic features of 6 PMMV occurring in patients age 49 to 83 years were evaluated retrospectively. The mean age of the patients was 68.2 years, and all patients were postmenopausal women. At the time of diagnosis, all tumors were limited to the vagina. Results (if a Case Study enter NA) Vaginal bleeding, discharge and a tumor mass were the chief complaints. These patients were treated by pelvic exenteration, radical surgery and postoperative chemotherapy and/or radiotherapy. Follow-up was available in all patients ranging from 1 to 7 years. Two patients had metastases in other organs died at 16 and 34 months respectively. Two patients had distant recurrence at 1 to 2 years and are still alive. The other 2 patients have no evidence of disease over 2 years follow-up. Grossly, the tumors were mostly polypoid and ranged from 0.25 to 9.5 cm (mean, 5 cm) in maximum dimension. The depth of invasion ranged from 2.2 to 11 mm. A vertical growth phase was present in all tumors. S-100, HMB-45 and Melan-A were positive in 100% of cases tested. Depth of invasion, mitotic index of tumor cells, tumor size, age, menopausal status, pelvic lymph node metastasis and lymphocytic infiltration show no tendency towards progression-free survival. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins. And adjuvant therapy was associated with progression-free survival. Conclusion In conclusion, PMMV is a rare disease, predominantly seen in women of postmenopausal age, and is associated with a poor prognosis. This study confirms S-100, HMB-45and Melan-A remains the most sensitive marker. Conventional predictors were of no prognostic value. Positive margin and adjuvant therapy were associated with progression-free survival. This report can facilitate the expansion of the phenotypic spectrum of gynecologic melanomas, and contribute to the prevention of misdiagnosis and inadequate treatment of PMMV.