CASE REPORTS
PRIMARY MALIGNANT MELANOMA OF MALE URETHRA LUCIANO ANTONIO ROBERTO CLAUDIO
CALCAGNO, M.D. CASARICO, M.D. BANDELLONI, M.D. GAMBINI, M.D.
From the Division of Urology and Pathology Service, Galliera Hospital, Genoa, Italy
ABSTRACT--A case o] primary malignant melanoma of the male urethra is reported. Trea included partial urethrectomy, bilateral inguinal and iliac lymphadenectomy, and post-su systemic chemotherapy. After thirty-six months, the patient is alive with cutaneous, pelvic l node, and gastric metastases.
Primary malignant melanoma of the male urethra is rare. In a review of the literature 23 eases have been reported.l-a2 Herein we report an additional case. Case Report A sixty-five-year-old man, who had been suffering from dysuria for one year, was seen in May, 1983. The physical examination showed a black nodular mass within the fossa navicularis, Glans and penis were normal, as was the skin on the rest of the body. Findings on excretory urography were normal, and urethroeystoseopy showed no other lesions of the urethra and bladder. Ocular melanoma was excluded. In May, 1983, he underwent partial urethreetomy and balanic urethrostomy (Fig. 1). Gross pathologic examination showed a blackish sessile polypous tumor with a large base, measuring 7 x 5 x 4 ram, surrounded by a macular lesion of the urethral mueosa. Microscopic examination revealed an invasive malignant melanoma with superficial intraepithelial aspects of radial spreading and, below this, a nodular intramueosal component of vertical spreading whose thickness was 4.64 mm (Fig. 2A). The superficial intraepithelial radial spreading component was similar to acrolentiginous melanoma (Fig. 2B). This component was not clearly delimited at the periphery of the le-
366
sion, but gradually faded into a lentigin lanoeytic hyperplasia with only light d~ ehanges (Fig. 2C). Diagnostic procedures, including the film, bone, liver, and brain scans, col ized tomography (CT), and lymphc were negative for metastases. The refused total peneetomy and, in June, 1! performed only bilateral superficial i and iliac lymphadeneetomy. Patholc amination showed an embolic microm~
FIGUI~E 1. Partial urethrectomy: polypous tumor surrounded by m urethral mucosa.
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~IGUItE2. Primary urethral malignant melanoma: ~A) view of sagittal section shows asymmetry, polyooid characteristic and lack of peripheric delimitation; (B) detail o] intraepithelial radial spreading ~hows dendritic fusi]orm or roundish atypical melanocites arranged whether separately at various levels or united in nests; and (C) lentiginous hyperplasia with pagetoid-like spreading aspects. (Hematoxylin and eosin; original magnifications [A] x 10, (B] x 200, [C] x 200.)
~ a l i g n a n t melanoma in the marginal sinus in N : 0 n e left inguinal lymph node out of 42
m ned! seqUently, c h e m o t h e r a p y
was started /mVday for 5 days at intern July to September, 1983. trd the patient refused chemuary, 1984, he came back ?k nodular lesions on the ~aminations were all negaThe patient again refused I underwent only excision of ruary, 1984. After further [C the patient was not seen , 1985, w h e n he showed melanoma metastases on 7pogastric skin. UrethrocysTeal urethral or bladder le~ s ? While a CT scan demonstrated bilateral ' ~vlcparavesical metastases. Four months la-
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/ APRIL 1991 / VOLUME XXXVII, NUMBER 4
ter an endoscopic gastric biopsy revealed intramucosal malignant melanoma metastases, confirmed by pathologic examination. The patient is currently alive with disease. Comment Among all malignant melanomas, mucosal localization accounts for 9 percent 2a and genitourinary tract for less than 1 percent. 24 Primary malignant melanoma of male urethra is rare and aggressive: as of now 23 cases are reported in the literature.l-2~ Our case is consistent with the data in the literature which report a greater frequency between the sixth and the eighth decades of life, with prevalent location in the fossa navicularis (14 cases) and tardy appearance of one or more of the following symptoms: urethral mass, dysuria, hematuria, melanuria, bloody urethral
367
(1939).
8. Chiappino G, and Strada R: Mali T male urethra, Cancro 15:121 (1962). 9. Salm R, and Rutter TE: A double pri noma of the fossa navicularis, Br J Urol 31 1O. da Silva JN, and Viegas AD: Melan tra masculina, Arq Pathol 38:73 (1966). 11. Pointon RC, and Poole-Wilson DS: the urethra, Br J Urol 40:682 (1968). 12. Guinn GA, and Ayala AG: Male ur~ 15 cases including a primary melanoma, J 13. Nola P, and Smud K: Rare case of u bri Oncol 1:187 (1972). 14. Geelhoed GW, and Myers GH Jr: the male urethra, J Urol 109:634 (1973). 15. Girgis AS, Bergman H, RosenthaI I~ usual penile malignancies in eircumcized J, 696 (1973). 16. Bracken RB, and Diokno AC: Mela the urethra: 2 case reports and review ot 111:198 (1974). 17. Iyer KM, Shah AL, Bapat RD, and : lignant melanoma of the male urethra, Ix (1974). 18. Konigsberg HA, and Gray GF: Ben lignant melanoma of penis and male ur, (1976). 19. Terada Y, and Takayasu H: Malign male urethra, Br J Urol 48:390 (1976). 20. Kokotas NS, Kallis EG, and Fokitis melanoma of male urethra, Urology 18:3 21. Weiss J, Elder D, and Hamilton R: urethra: surgical approach and pathologic 382 (1982). 22. Begun FP, Grosman HB, Diokno A( lignant melanoma of the penis and male u
6. Berry NE, and Reese L: Malignant melanoma which had its first clinical manifestations in the prostate gland, J Urol 69:286 (1953). 7. Signorelli E: I tumori primitivi dell'uretra maschile, Urologia 29:530 (1962).
23. Iversen K, and Robins RE: Muc nomas, Am J Surg 139:660 (1980). 24. Stein BS, and Kendall AR: Maligl genitourinary tract, J Urol 132:859 (1984/.
discharge, split urinary stream, obstructive symptoms. Several therapies, separately or in different varations have been used: partial or total urethrectomy, partial or total peneetomy, inguinal and/or iliac lymphadenectomy, radiotherapy, and chemotherapy. Analyzing all the cases reported and our personal experience, we conclude that diagnosis and aggressive therapy are necessary as early as possible to improve survival rates. Via A. Volta 8 16128 Genoa, Italy (DR. CALCAGNO) References 1. Frick W, and Hall FJ: Generalized multiple pigmented sarcoma originating in the skin, JAMA 46:1911 (1906). 2. Albrecht H: Ein Naevus Papillaris Pigmentosus der Pars Prostatica der Urethra mit sarko-karzinomatosen Metastasen, Verhandl deutsch path Gesellsch 14:253 (1910). 3. Campbell MF, and Fein MJ: Malignant melanoma of the penile urethra with a brief review of urethral sarcoma in the male, J Urol 35:573 (1936). 4. McKenna CM: Melanoblastoma of penile urethra, Trans Am Assoc Genitourin Surg 30:401 (1937). 5. Shih HE: Melanoma of urethra, Am J Cancer 36:243
368
(1984).
UROLOGY
/
APRIL 1991
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VOLUME XXXVII'N~t~
PRIMARY MALIGNANT MELANOMA OF MALE URETHRA LUCIANO ANTONIO ROBERTO CLAUDIO
CALCAGNO, M.D. CASARICO, M.D. BANDELLONI, M.D. GAMBINI, M.D.
From the Division of Urology and Pathology Service, Galliera Hospital, Genoa, Italy
ABSTRACT--A case o] primary malignant melanoma of the male urethra is reported. Trea included partial urethrectomy, bilateral inguinal and iliac lymphadenectomy, and post-su systemic chemotherapy. After thirty-six months, the patient is alive with cutaneous, pelvic l node, and gastric metastases.
Primary malignant melanoma of the male urethra is rare. In a review of the literature 23 eases have been reported.l-a2 Herein we report an additional case. Case Report A sixty-five-year-old man, who had been suffering from dysuria for one year, was seen in May, 1983. The physical examination showed a black nodular mass within the fossa navicularis, Glans and penis were normal, as was the skin on the rest of the body. Findings on excretory urography were normal, and urethroeystoseopy showed no other lesions of the urethra and bladder. Ocular melanoma was excluded. In May, 1983, he underwent partial urethreetomy and balanic urethrostomy (Fig. 1). Gross pathologic examination showed a blackish sessile polypous tumor with a large base, measuring 7 x 5 x 4 ram, surrounded by a macular lesion of the urethral mueosa. Microscopic examination revealed an invasive malignant melanoma with superficial intraepithelial aspects of radial spreading and, below this, a nodular intramueosal component of vertical spreading whose thickness was 4.64 mm (Fig. 2A). The superficial intraepithelial radial spreading component was similar to acrolentiginous melanoma (Fig. 2B). This component was not clearly delimited at the periphery of the le-
366
sion, but gradually faded into a lentigin lanoeytic hyperplasia with only light d~ ehanges (Fig. 2C). Diagnostic procedures, including the film, bone, liver, and brain scans, col ized tomography (CT), and lymphc were negative for metastases. The refused total peneetomy and, in June, 1! performed only bilateral superficial i and iliac lymphadeneetomy. Patholc amination showed an embolic microm~
FIGUI~E 1. Partial urethrectomy: polypous tumor surrounded by m urethral mucosa.
UROLOGY
/
APRIL 1991
/
VOLUME XXXVII' : .............
~IGUItE2. Primary urethral malignant melanoma: ~A) view of sagittal section shows asymmetry, polyooid characteristic and lack of peripheric delimitation; (B) detail o] intraepithelial radial spreading ~hows dendritic fusi]orm or roundish atypical melanocites arranged whether separately at various levels or united in nests; and (C) lentiginous hyperplasia with pagetoid-like spreading aspects. (Hematoxylin and eosin; original magnifications [A] x 10, (B] x 200, [C] x 200.)
~ a l i g n a n t melanoma in the marginal sinus in N : 0 n e left inguinal lymph node out of 42
m ned! seqUently, c h e m o t h e r a p y
was started /mVday for 5 days at intern July to September, 1983. trd the patient refused chemuary, 1984, he came back ?k nodular lesions on the ~aminations were all negaThe patient again refused I underwent only excision of ruary, 1984. After further [C the patient was not seen , 1985, w h e n he showed melanoma metastases on 7pogastric skin. UrethrocysTeal urethral or bladder le~ s ? While a CT scan demonstrated bilateral ' ~vlcparavesical metastases. Four months la-
~,~C¥
/ APRIL 1991 / VOLUME XXXVII, NUMBER 4
ter an endoscopic gastric biopsy revealed intramucosal malignant melanoma metastases, confirmed by pathologic examination. The patient is currently alive with disease. Comment Among all malignant melanomas, mucosal localization accounts for 9 percent 2a and genitourinary tract for less than 1 percent. 24 Primary malignant melanoma of male urethra is rare and aggressive: as of now 23 cases are reported in the literature.l-2~ Our case is consistent with the data in the literature which report a greater frequency between the sixth and the eighth decades of life, with prevalent location in the fossa navicularis (14 cases) and tardy appearance of one or more of the following symptoms: urethral mass, dysuria, hematuria, melanuria, bloody urethral
367
(1939).
8. Chiappino G, and Strada R: Mali T male urethra, Cancro 15:121 (1962). 9. Salm R, and Rutter TE: A double pri noma of the fossa navicularis, Br J Urol 31 1O. da Silva JN, and Viegas AD: Melan tra masculina, Arq Pathol 38:73 (1966). 11. Pointon RC, and Poole-Wilson DS: the urethra, Br J Urol 40:682 (1968). 12. Guinn GA, and Ayala AG: Male ur~ 15 cases including a primary melanoma, J 13. Nola P, and Smud K: Rare case of u bri Oncol 1:187 (1972). 14. Geelhoed GW, and Myers GH Jr: the male urethra, J Urol 109:634 (1973). 15. Girgis AS, Bergman H, RosenthaI I~ usual penile malignancies in eircumcized J, 696 (1973). 16. Bracken RB, and Diokno AC: Mela the urethra: 2 case reports and review ot 111:198 (1974). 17. Iyer KM, Shah AL, Bapat RD, and : lignant melanoma of the male urethra, Ix (1974). 18. Konigsberg HA, and Gray GF: Ben lignant melanoma of penis and male ur, (1976). 19. Terada Y, and Takayasu H: Malign male urethra, Br J Urol 48:390 (1976). 20. Kokotas NS, Kallis EG, and Fokitis melanoma of male urethra, Urology 18:3 21. Weiss J, Elder D, and Hamilton R: urethra: surgical approach and pathologic 382 (1982). 22. Begun FP, Grosman HB, Diokno A( lignant melanoma of the penis and male u
6. Berry NE, and Reese L: Malignant melanoma which had its first clinical manifestations in the prostate gland, J Urol 69:286 (1953). 7. Signorelli E: I tumori primitivi dell'uretra maschile, Urologia 29:530 (1962).
23. Iversen K, and Robins RE: Muc nomas, Am J Surg 139:660 (1980). 24. Stein BS, and Kendall AR: Maligl genitourinary tract, J Urol 132:859 (1984/.
discharge, split urinary stream, obstructive symptoms. Several therapies, separately or in different varations have been used: partial or total urethrectomy, partial or total peneetomy, inguinal and/or iliac lymphadenectomy, radiotherapy, and chemotherapy. Analyzing all the cases reported and our personal experience, we conclude that diagnosis and aggressive therapy are necessary as early as possible to improve survival rates. Via A. Volta 8 16128 Genoa, Italy (DR. CALCAGNO) References 1. Frick W, and Hall FJ: Generalized multiple pigmented sarcoma originating in the skin, JAMA 46:1911 (1906). 2. Albrecht H: Ein Naevus Papillaris Pigmentosus der Pars Prostatica der Urethra mit sarko-karzinomatosen Metastasen, Verhandl deutsch path Gesellsch 14:253 (1910). 3. Campbell MF, and Fein MJ: Malignant melanoma of the penile urethra with a brief review of urethral sarcoma in the male, J Urol 35:573 (1936). 4. McKenna CM: Melanoblastoma of penile urethra, Trans Am Assoc Genitourin Surg 30:401 (1937). 5. Shih HE: Melanoma of urethra, Am J Cancer 36:243
368
(1984).
UROLOGY
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APRIL 1991
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VOLUME XXXVII'N~t~
