Primary Malignant Melanoma of the Urethra Detected by Urine Cytology in a Male Patient Dear Editor: We read with interest the recent article by Hori et al. describing primary bladder melanoma diagnosed on voided urine cytology.1 Herein, we present a case of primary urethral melanoma diagnosed as suspicious for melanoma on voided urine cytology. To our knowledge, there have been rare case reports of primary bladder melanoma and one report of a primary urethral melanoma detected by urine cytology.1–3
Case The patient was an 81-year-old man who presented to his urologist with benign prostatic hyperplasia and bladder outlet obstruction in the setting of a long history of lower urinary tract symptoms and hematuria for several months. Bladder outlet obstruction was demonstrated on urodynamics and attributed to an enlarged prostate. To evaluate for malignancy, voided urine was submitted and prepared R (TP) slide as one Papanicolaou (Pap)-stained ThinPrepV (Hologic, Boxborough, MA). Two prior voided urine specimens prepared similarly were negative for malignant cells over the prior 7 months. On microscopic examination, there were scattered large abnormal cells occurring singly and in small clusters (Figs. 1 and 2). The cells had enlarged nuclei, high nuclear-to-cytoplasmic (N/C) ratios, and prominent nucleoli. Several of the cells were bi- and multi-nucleate, and many contained dark-brown cytoplasmic pigment. The findings were suspicious for melanoma. A biopsy of the penile urethra performed 5 months later was diagnosed as melanoma (Fig. 3), confirmed by positive immunostaining for S100, HMB-45, and MelanA, and negative pancytokeratin. A subsequent right axillary lymph node biopsy revealed metastatic melanoma. *Correspondence to: Robert A. DeSimone, M.D., Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, Starr 1036, New York, NY 10065, USA. E-mail: [email protected] Received 21 November 2014; Revised 1 January 2015; Accepted 31 January 2015 DOI: 10.1002/dc.23258 Published online 19 February 2015 in Wiley Online Library (wileyonlinelibrary.com).
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Diagnostic Cytopathology, Vol. 43, No 8
The patient had no history or clinical evidence of a primary skin melanoma.
Discussion Primary malignant melanomas of the genitourinary tract are rare, representing
Case The patient was an 81-year-old man who presented to his urologist with benign prostatic hyperplasia and bladder outlet obstruction in the setting of a long history of lower urinary tract symptoms and hematuria for several months. Bladder outlet obstruction was demonstrated on urodynamics and attributed to an enlarged prostate. To evaluate for malignancy, voided urine was submitted and prepared R (TP) slide as one Papanicolaou (Pap)-stained ThinPrepV (Hologic, Boxborough, MA). Two prior voided urine specimens prepared similarly were negative for malignant cells over the prior 7 months. On microscopic examination, there were scattered large abnormal cells occurring singly and in small clusters (Figs. 1 and 2). The cells had enlarged nuclei, high nuclear-to-cytoplasmic (N/C) ratios, and prominent nucleoli. Several of the cells were bi- and multi-nucleate, and many contained dark-brown cytoplasmic pigment. The findings were suspicious for melanoma. A biopsy of the penile urethra performed 5 months later was diagnosed as melanoma (Fig. 3), confirmed by positive immunostaining for S100, HMB-45, and MelanA, and negative pancytokeratin. A subsequent right axillary lymph node biopsy revealed metastatic melanoma. *Correspondence to: Robert A. DeSimone, M.D., Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, Starr 1036, New York, NY 10065, USA. E-mail: [email protected] Received 21 November 2014; Revised 1 January 2015; Accepted 31 January 2015 DOI: 10.1002/dc.23258 Published online 19 February 2015 in Wiley Online Library (wileyonlinelibrary.com).
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Diagnostic Cytopathology, Vol. 43, No 8
The patient had no history or clinical evidence of a primary skin melanoma.
Discussion Primary malignant melanomas of the genitourinary tract are rare, representing
