Scandinavian Journal of Urology and Nephrology
ISSN: 0036-5599 (Print) 1651-2065 (Online) Journal homepage: http://www.tandfonline.com/loi/isju19
Primary Malignant Melanoma of the Urinary Bladder Lars Lund, Lone Storgård & Hanne Noer To cite this article: Lars Lund, Lone Storgård & Hanne Noer (1992) Primary Malignant Melanoma of the Urinary Bladder, Scandinavian Journal of Urology and Nephrology, 26:2, 205-206, DOI: 10.1080/00365599.1992.11690458 To link to this article: http://dx.doi.org/10.1080/00365599.1992.11690458
Published online: 31 Mar 2016.
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Citing articles: 1 View citing articles
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Date: 13 June 2016, At: 03:29
Scand J Urol Nephrol 26: 205-206, 1992
PRIMARY MALIGNANT M ELANOMA OF THE URINARY BLADDER Case R eport
Lars Lund , Lone Storgftrd and Han nc Nocr From !he Depar/m enls of Urology and Pa!hology, Aalborg Hospital, Aalborg, DeiJinark
Downloaded by [Australian National University] at 03:29 13 June 2016
(Submitt ed March 27, 1991 . Accepted for pub li ca ti on October II , 199 1)
Prim ary ma li gnant melanoma in the bladder has to our knowledge o nl y been reported in th e literatu re in 9 cases (I ,3}. We here prese nt th e first case report of thi s type of mel a noma in Scandinavia . CASE R EPORT An 80-year-old prev iously heal th y man was ad mitted to our Depa rtm ent because of monosy mpt omati c hematuri a during a two months period . He had no other urological symptoms. Routine blood tests and X-ray oft he chest we re normal. Intravenous pyelography demonstrated a fillin g defect of the bladder but was otherwise norm al. Cystoscopy revealed a large prostate and an eleva ted darkly stain ed tumor present in the anterior wall of th e bladder. Biopsies from the tum or showed malignant melanoma of ei ther pri mary or metastati c origin . Two months later the patient was ad mitted for a co ntrol cystoscopy, wh ich showed a typica ll y malignant dark melanoma in vadi ng the superficial bladder wall. A transurethral resection was ca rried out and spec im ens fro m the tumor were grossly pigmented . Hi stological ly, large polygonal brown pigment cell s with irregul ar nuclei, macronucleoles and mitoses were numerous in the les ion (Fig. I). The tum or cell s in vaded the underl ying muscular laye rs of the bl adde r wa ll. No metastases were demonstrated , and careful clini cal exa mination includin g th e sk in and eyes showed no other malignant melano ma. One year later the patient was still in good hea lth wi th a normal clinical exa minati on and a norm al cystoscopy.
It is difficult to expla in th e hi stogenesis of primary bladder melanom as, sin ce melanocytes have not bee n obse rved in normal urothelium or in portions of its epid ermoid metapla sia (3). At least three theories ex plaining th e ge nes is a re possible. Ectopic or dysembryoplastic remn a nts may co nt a in melanocytes. Second, th e urotheli al stem cell s may have undergone metaplasia and finally th e melanocytes co uld belong to th e e ndocrine polypepti de cells of the APUD se ri es. In thi s case the diagnosis of mali gnant melanoma was co nfirm ed by the positi ve immunohi stochemica l reaction with anti-S- I 00-protein a nd anti-melanoma-specific antibody HBM 45 . Th e pi gment of th e tumor cells was shown to be melanin by special sta in (Lillie; Fig.2). Mali gna nt melanoma , although very rare, may be added to th e long li st of di sease states leading to he maturia. Th e course of event s indi-
DISCUSSION Mali gnant melanom a in th e urinary tra ct is very ra re, but a few cases in th e kidney, bladder a nd urethra ha ve previously bee n reported (5). Th e bladder is th e most common site in th e urin ary tract for metastati c melanoma, but still less than 75 cases have bee n reported in the literature (2, 4).
Fig. I. Less pigmented area of tumor with tenformed cell s with nucleopleomorfi sm and coarse chrom atin structure. At the bottom a dark pigmented part of the tumour is shown . Scand J Uro/ Nephrol 26
206
L. Lund et a/. m ela no m a of the bl adder ca n occur, and reco mm end cystoscopy to be included in the in vesti gation programm e wh eneve r chas in g th e prim ary tumor in pati ent s with metasta ti c melanoma.
Downloaded by [Australian National University] at 03:29 13 June 2016
R EFE R ENCES I. Ainsworth AM, Clark WH , Mastrangelo M, Conger KB . Prim ary mali gnant melanoma of the urinary bladder. Ca ncer 1976; 37: 1928- 1936 . 2. Alhede J, Kraru p T. Melanom metastaser i bla:: ren. Ugesk r Laeger 1980; 142: 1225- 1226. 3. Goldschmi dt P, Py JM , Kostakopoul os A, Jacomin E, Grosshans E, Bollack C. Prim ary malignant melanomas of th e urin ary bl adder. Br J U rol 1988; 6 1:359.
Fig. 2. Tumour cell s showing fin e melanin-granul a in the cytopl asm. Dark cell s with coa rse granula are melanophages. Lilli e x 180. cates that th e tumor in thi s report was of prim ary type. Th e trea tment is tra nsurethral resection a nd coagul ation . We conclud e, th at although ra re, prim a ry
Scand J Ural Nephro/ 26
4. Gupta NP, Rav i R, Mathur M. Metastatic melanomas of bladder with occult prim ary presenting as haematuri a-a case report and rev iew of literature. Indi an J Ca nce r 1966; 23 : 222-225. 5. Oldbring J, Mi kul owsk i P. Maligna nt melanoma of the penis and male urethra. Ca ncer 1987; 59: 58 1-587.
ISSN: 0036-5599 (Print) 1651-2065 (Online) Journal homepage: http://www.tandfonline.com/loi/isju19
Primary Malignant Melanoma of the Urinary Bladder Lars Lund, Lone Storgård & Hanne Noer To cite this article: Lars Lund, Lone Storgård & Hanne Noer (1992) Primary Malignant Melanoma of the Urinary Bladder, Scandinavian Journal of Urology and Nephrology, 26:2, 205-206, DOI: 10.1080/00365599.1992.11690458 To link to this article: http://dx.doi.org/10.1080/00365599.1992.11690458
Published online: 31 Mar 2016.
Submit your article to this journal
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isju19 Download by: [Australian National University]
Date: 13 June 2016, At: 03:29
Scand J Urol Nephrol 26: 205-206, 1992
PRIMARY MALIGNANT M ELANOMA OF THE URINARY BLADDER Case R eport
Lars Lund , Lone Storgftrd and Han nc Nocr From !he Depar/m enls of Urology and Pa!hology, Aalborg Hospital, Aalborg, DeiJinark
Downloaded by [Australian National University] at 03:29 13 June 2016
(Submitt ed March 27, 1991 . Accepted for pub li ca ti on October II , 199 1)
Prim ary ma li gnant melanoma in the bladder has to our knowledge o nl y been reported in th e literatu re in 9 cases (I ,3}. We here prese nt th e first case report of thi s type of mel a noma in Scandinavia . CASE R EPORT An 80-year-old prev iously heal th y man was ad mitted to our Depa rtm ent because of monosy mpt omati c hematuri a during a two months period . He had no other urological symptoms. Routine blood tests and X-ray oft he chest we re normal. Intravenous pyelography demonstrated a fillin g defect of the bladder but was otherwise norm al. Cystoscopy revealed a large prostate and an eleva ted darkly stain ed tumor present in the anterior wall of th e bladder. Biopsies from the tum or showed malignant melanoma of ei ther pri mary or metastati c origin . Two months later the patient was ad mitted for a co ntrol cystoscopy, wh ich showed a typica ll y malignant dark melanoma in vadi ng the superficial bladder wall. A transurethral resection was ca rried out and spec im ens fro m the tumor were grossly pigmented . Hi stological ly, large polygonal brown pigment cell s with irregul ar nuclei, macronucleoles and mitoses were numerous in the les ion (Fig. I). The tum or cell s in vaded the underl ying muscular laye rs of the bl adde r wa ll. No metastases were demonstrated , and careful clini cal exa mination includin g th e sk in and eyes showed no other malignant melano ma. One year later the patient was still in good hea lth wi th a normal clinical exa minati on and a norm al cystoscopy.
It is difficult to expla in th e hi stogenesis of primary bladder melanom as, sin ce melanocytes have not bee n obse rved in normal urothelium or in portions of its epid ermoid metapla sia (3). At least three theories ex plaining th e ge nes is a re possible. Ectopic or dysembryoplastic remn a nts may co nt a in melanocytes. Second, th e urotheli al stem cell s may have undergone metaplasia and finally th e melanocytes co uld belong to th e e ndocrine polypepti de cells of the APUD se ri es. In thi s case the diagnosis of mali gnant melanoma was co nfirm ed by the positi ve immunohi stochemica l reaction with anti-S- I 00-protein a nd anti-melanoma-specific antibody HBM 45 . Th e pi gment of th e tumor cells was shown to be melanin by special sta in (Lillie; Fig.2). Mali gna nt melanoma , although very rare, may be added to th e long li st of di sease states leading to he maturia. Th e course of event s indi-
DISCUSSION Mali gnant melanom a in th e urinary tra ct is very ra re, but a few cases in th e kidney, bladder a nd urethra ha ve previously bee n reported (5). Th e bladder is th e most common site in th e urin ary tract for metastati c melanoma, but still less than 75 cases have bee n reported in the literature (2, 4).
Fig. I. Less pigmented area of tumor with tenformed cell s with nucleopleomorfi sm and coarse chrom atin structure. At the bottom a dark pigmented part of the tumour is shown . Scand J Uro/ Nephrol 26
206
L. Lund et a/. m ela no m a of the bl adder ca n occur, and reco mm end cystoscopy to be included in the in vesti gation programm e wh eneve r chas in g th e prim ary tumor in pati ent s with metasta ti c melanoma.
Downloaded by [Australian National University] at 03:29 13 June 2016
R EFE R ENCES I. Ainsworth AM, Clark WH , Mastrangelo M, Conger KB . Prim ary mali gnant melanoma of the urinary bladder. Ca ncer 1976; 37: 1928- 1936 . 2. Alhede J, Kraru p T. Melanom metastaser i bla:: ren. Ugesk r Laeger 1980; 142: 1225- 1226. 3. Goldschmi dt P, Py JM , Kostakopoul os A, Jacomin E, Grosshans E, Bollack C. Prim ary malignant melanomas of th e urin ary bl adder. Br J U rol 1988; 6 1:359.
Fig. 2. Tumour cell s showing fin e melanin-granul a in the cytopl asm. Dark cell s with coa rse granula are melanophages. Lilli e x 180. cates that th e tumor in thi s report was of prim ary type. Th e trea tment is tra nsurethral resection a nd coagul ation . We conclud e, th at although ra re, prim a ry
Scand J Ural Nephro/ 26
4. Gupta NP, Rav i R, Mathur M. Metastatic melanomas of bladder with occult prim ary presenting as haematuri a-a case report and rev iew of literature. Indi an J Ca nce r 1966; 23 : 222-225. 5. Oldbring J, Mi kul owsk i P. Maligna nt melanoma of the penis and male urethra. Ca ncer 1987; 59: 58 1-587.
