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Presented by Dr. Andres Matoso and prepared by Dr. Tatianna Larman.
An 84 year old woman with a urethral lesion.
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Question 1 of 1
1. Question
An 84 year old woman with a urethral lesion. Choose the correct diagnosis.
Correct
Answer: Urethral melanoma
Histology: Ulcerated polypoid lesion with highly atypical cells with marked nuclear pleomorphism, prominent nucleoli and brisk mitotic activity. There are areas of spindle morphology mimicking a high-grade sarcoma or sarcomatoid carcinoma. There are areas of focal pigment that is difficult to differentiate between melanin and hemosiderin.
Discussion: Primary urethral melanoma is rare and comprises 0.2% of all melanomas and 4% of all urethral primary malignancies. Older women are most frequently affected and the distal urethra is involved in the majority of cases. Primary malignant melanomas of the urethra, one fifth of which are amelanotic, must be included in the differential diagnosis of a number of primary neoplasms that involve the urethra, including urothelial carcinoma, sarcomatoid carcinoma, and sarcomas. The high-grade features and, in some cases, the presence of pigment should suggest the diagnosis. Immunohistochemistry for melanocytic markers are usually needed for a definitive diagnosis.
References:
1. Int Urogynecol J (2015) 26:149–150
2. Kim CJ, Pak K, Hamaguchi A, Ishida A, Arai Y, Konishi T, et al. Primary malignant melanoma of the female urethra. Cancer 1993;71:448-51.
3. Oliva E, Quinn TR, Amin MB, Eble JN, Epstein JI, Srigley JR, et al. Primary malignant melanoma of the urethra: A clinicopathologic analysis of 15 cases. Am J Surg Pathol 2000;24:785-96.Incorrect
Answer: Urethral melanoma
Histology: Ulcerated polypoid lesion with highly atypical cells with marked nuclear pleomorphism, prominent nucleoli and brisk mitotic activity. There are areas of spindle morphology mimicking a high-grade sarcoma or sarcomatoid carcinoma. There are areas of focal pigment that is difficult to differentiate between melanin and hemosiderin.
Discussion: Primary urethral melanoma is rare and comprises 0.2% of all melanomas and 4% of all urethral primary malignancies. Older women are most frequently affected and the distal urethra is involved in the majority of cases. Primary malignant melanomas of the urethra, one fifth of which are amelanotic, must be included in the differential diagnosis of a number of primary neoplasms that involve the urethra, including urothelial carcinoma, sarcomatoid carcinoma, and sarcomas. The high-grade features and, in some cases, the presence of pigment should suggest the diagnosis. Immunohistochemistry for melanocytic markers are usually needed for a definitive diagnosis.
References:
1. Int Urogynecol J (2015) 26:149–150
2. Kim CJ, Pak K, Hamaguchi A, Ishida A, Arai Y, Konishi T, et al. Primary malignant melanoma of the female urethra. Cancer 1993;71:448-51.
3. Oliva E, Quinn TR, Amin MB, Eble JN, Epstein JI, Srigley JR, et al. Primary malignant melanoma of the urethra: A clinicopathologic analysis of 15 cases. Am J Surg Pathol 2000;24:785-96.
