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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2009 February;61(1):77-80
Malignant melanoma metastasizing to the uterus in a patient with atypical postmenopause metrorrhagia. A case report
Simeone S., Laterza M. M., Scaravilli G., Capuano S., Serao M., Orabona P., Rossi R., Balbi C.
1 Freelance Doctor
2 Unit of Ginecology and Obstetrics Sant’Anna and S. Sebastiano Hospital, Caserta, Italy
3 Operative Unit of Pathological Anatomy Sant’Anna and S. Sebastiano Hospital, Caserta Italy
The uterine metastases of melanoma are very rare. At the present time, only one case occurred in our department. Case report: a 54-year-old plurigravid woman showed a metrorrhagia of unknown origin. The patient underwent a diagnostic hysteroscopy and an endometrial biopsy, in order to investigate the symptomatic postmenopausal bleeding and exclude a neoplasia, such as the endometrial carcinoma. The patient was discharged with a diagnosis of uterine fibromatosis and called back to go through a complete laparohysterectomy and bilateral annessiectomy. During the operation, some metastases were found in the genital tract. An accurate physical examination allowed us to discover a cutaneous nevus, the excision and histology of which revealed its malignancy. The immunohistochemistry of the surgical sample was able to confirm the hypothesized relationship between the nevus and the metastases, thus leading to the diagnosis of malignant melanoma metastating the genital tract. It is important to make an accurate diagnostic passage to exclude tumoral pathology in patients with atypical uterine bleeding. Every uterine bleeding of the postmenopausal period (abnormal uterine bleeding, AUB) is considered atypical and it has to be early investigated, in order to exclude any endometrial cancer. The nature of the uterine bleedings can be ascribed to atrophy, dysfunctional matters (dysfunctional uterine bleeding, DBU), benign organic alterations, only in 7-10% of cases to endometrial cancer and more rarely to metastatic tumours, as well as this case of melanoma. Physicians should be aware of such unusual possibilities in order to look carefully for metastatic implants in adenomyomas.