IHC: a sole tool in Dx a rare case of vaginal amelanotic mel
The present case has been reported in the journal Obstet Gynecol Sci.

A 53-year-old woman who was menopausal for 10 years presented with postmenopausal bleeding for 4–5 months. On examination, her abdomen was unremarkable, but vaginal examination revealed a friable growth of the posterior wall extending up to the fornices, whereas the anterior wall and cervix appeared normal. The growth was white in color with areas of hemorrhage, soft in consistency, and bled easily on touch.

A biopsy was taken. Microscopic examination revealed soft tissue fragments lined by acanthotic stratified squamous epithelium with extensive areas of ulceration. A malignant tumor was seen in the subepithelium, arranged in nests, alveoli, trabeculae, and as singly scattered cells, separated by thin fibrous septa. A radial pattern of growth with junctional activity was present.

Tumor cells were markedly pleomorphic, round to polygonal or spindle-shaped, and had eccentrically placed nuclei with conspicuous nucleoli along with scant to moderate cytoplasm. Focal intranuclear inclusions, eosinophilic macronuclei, nuclear grooving, intracellular/extracellular, hyaline globules and few binucleated/multinucleated giant cells were seen as well. Numerous atypical and bizarre mitotic figures were noted. There was a lymphocytic infiltrate and large areas of necrosis. Lymphovascular emboli were seen.

Immunohistochemistry was used to confirm the diagnosis. Tumor cell cytoplasm was strongly-positive for HMB45 and vimentin, and both nucleus and cytoplasm were positive for S-100. Cells were negative for cytokeratin.

The final diagnosis was primary vaginal amelanotic melanoma based on final cutaneous and ocular examination. Chest computed tomography was suggestive of metastatic nodules in bilateral lungs. Multi-agent chemotherapy (cisplatin and adriamycin) and hypofractionated radiotherapy were initiated.

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Dr. B●●●l D●s
Dr. B●●●l D●s Obstetrics and Gynaecology
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Dec 1, 2018Like