Pussy Adona Adona

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Try out PMC Labs and tell us what you think. Learn More. Language: English Turkish. Primary melanoma of the vagina is a rare neoplasm that appears in the 6 th and 7 th decades of life. It has a poor prognosis, for which there is no consensus regarding treatment; indeed, the literature describes a of therapeutic options.

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This paper describes a patient with vaginal melanoma treated by local excision and immunotherapy. Vaginal melanoma is an uncommon form of melanoma, affecting an area not exposed to ultraviolet radiation 1. About 1. It mainly affects postmenopausal women in their 6 th and 7 th decade of life 5 and usually has no accompanying symptoms.

However, some vaginal melanomas can lead to vaginal bleeding and an increase in discharge, and on some occasions a palpable mass can be felt 6. Vaginal melanomas are usually localised in the lower third of the vagina and appear as multicentric, somewhat elevated lesions.

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They are very aggressive tumours and overall survival rates are very low. This type of tumour carries a high risk of long distance metastases and local recurrence shortly after surgery; disease-free time is therefore usually short 8.

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The rarity of this condition means treatment is not well defined. Local excision, radical surgery, radiotherapy, chemotherapy and immunotherapy, or some combination of these, have been described by different authors 6. The present work describes a patient with vaginal melanoma, the treatment provided, and a review of the pertinent literature in PubMed Medline.

A 63 year-old patient with a background of adenocarcinoma of the endometrium FIGO 1A G2treated surgically for this condition at our centre inattended a routine follow-up appointment in Marchduring which a hyperpigmented, multifocal, slightly ulcerated lesion Pussy Adona Adona the lower third of the vagina posterior wall was detected.

This lesion was under 3 cm in diameter and in contact with the external edge of the vagina Fig. The remainder of the vagina was free of disease. No palpable inguinal lymphatic ganglia were detected, and a pelvic examination was normal.

The patient was asymptomatic and showed no skin lesions suspicious of melanoma. A biopsy of the affected area returned a result of squamous mucosa with melanoma and the presence of round cells. A thoracic-abdominal-pelvic CT scan was normal. The patient was treated surgically, involving complete excision of the affected vagina with a safety margin of 2 cm. Bilateral inguinal lymphadenectomy was also performed. Histological analysis returned a result of vaginal melanoma in the vertical growth phase, with three nodular lesions measuring 1.

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The maximum thickness of the lesion was 9 mm. Extensive perineural invasion was noted with a mitotic index of four mitoses per 10 high power field Fig. The resection margins were histologically free of neoplastic involvement. The inguinal lymphatic glands were negative. Staining with haematoxylin-eosin x. Note the nests of atypical melanocytic cells at the junction between the epithelium and the subepithelial connective tissue, reflecting neoplastic activity. Note atypical cells of variable size and nuclear morphology, with coarse chromatin and occasional prominent nucleoli.

Note the intracytoplasmic granular pigment melanin. In a PET CT scan performed seven months after surgery, the patient showed submillimetric pulmonary lesions compatible with metastases; this was confirmed histologically following radioguided punction. Palliative chemotherapy was provided. At one year post diagnosis the patient is alive but with disease. Primary melanoma of the vagina is a rare neoplasm that usually affects adult women. The literature only describes some cases 10which explains the lack of consensus regarding its treatment Studies have shown that vaginal melanoma usually appears in the 6 th and 7 th decades of life At the time of diagnosis the present patient was 63 years old.

These tumours commonly have no accompanying symptoms 11 and are usually found by chance, as in the present case. The most common symptoms, when they occur, are vaginal bleeding and an increase in vaginal discharge; in some cases a palpable mass can be detected 2. The prognosis of patients with melanoma is poor. In a meta-analysis performed by Buchanan et al. Only two patients survived 10 years and both suffered recurrences that required various treatments A of factors have been associated with a poorer prognosis, the most important of which appears to be tumour size The thickness of the tumour does not appear to affect overall survival.

Certainly, cell type, of mitotic cells, ulceration, vascular involvement and amelanosis all appear to affect survival The FIGO staging system is probably not the optimum for use with vaginal cancers since it does not contemplate tumour size which is important in vaginal melanoma or the study of the lymph glands Some authors suggest that the Breslow method, which is valid for cutaneous melanomas, could be used in the early stages of vaginal melanomas.

Clark levels, however, do Pussy Adona Adona seem applicable given the absence of dermal and subcutaneous papillary and reticular structures 4 Thus, the staging of vaginal melanomas can be difficult, with the microstaging method of Breslow 14 perhaps being the best available Most authors suggest surgical treatment 131017although the benefit of radical surgery over conservative surgery has not been demonstrated always supposing the margins are tumour-free 10 Non-tumour-free resection margins favour local recurrence and are associated with a poorer prognosis No difference has been demonstrated between radical and conservative surgery either in terms of overall survival or disease-free survival.

Adjuvant pelvic radiotherapy and brachytherapy may help in the locoregional control of the disease Radiotherapy and chemotherapy are indicated when a tumour is nonresectable 10although the role of chemotherapy in patients with distant metastases has Pussy Adona Adona been established. Although lymphadenectomy is controversial 17some authors advise pelvic lymphadenectomy for tumours affecting the mid and upper thirds of the vagina, and inguinal lymphadenectomy for those affecting the lower third 4.

However, the pelvic ganglia are not usually involved. Examination of the sentinel node, normally a matter of course for melanoma in other locations, should provide the information necessary to identify which patients require complete lymphadenectomy 1. The sentinel node illustrates the status of Pussy Adona Adona regional ganglia, obviating the need to perform exhaustive lymphadenectomy and thus avoiding the morbidity this entails. In addition, it allows the presence of micrometastases to be diagnosed. If the surgical team has sufficient experience, sentinel node examination before lymphadenectomy could therefore be of benefit; unfortunately no such experience was available in the context of vaginal melanoma at our centre when the present patient underwent surgery.

In conclusion, vaginal melanomas are uncommon, highly aggressive tumours that are associated with poor overall survival. There is no consensus regarding treatment, but the combination of different therapies, plus local excision of the lesion and investigation of the sentinel node, if possible, would appear to be a reasonable option. The authors thank the librarian Ms. Eulalia Grifol Clar for excellent assistance with the literature search. This work is dedicated to the memory of Dr.

Conflict of interest. National Center for Biotechnology InformationU. J Turk Ger Gynecol Assoc. Published online Mar 1. Author information Article notes Copyright and information Disclaimer. Received May 27; Accepted Jun This article has been cited by other articles in PMC. Abstract Primary melanoma of the vagina is a rare neoplasm that appears in the 6 th and 7 th decades of life.

Keywords: Vaginal neoplasms, melanoma, treatment, prognosis. Introduction Vaginal melanoma is an uncommon form of melanoma, affecting an area not exposed to Pussy Adona Adona radiation 1. Clinical case A 63 year-old patient with a background of adenocarcinoma of the endometrium FIGO 1A G2treated surgically for this condition at our centre inattended a routine follow-up appointment in Marchduring which a hyperpigmented, multifocal, slightly ulcerated lesion affecting the lower third of the vagina posterior wall was detected. Open in a separate window. Figure 1. Table 1 Immunohistochemical analysis.

Figure 2. Figure 3. Discussion Primary melanoma of the vagina is a rare neoplasm that usually affects adult women. Acknowledgements The authors thank the librarian Ms. Footnotes This work is dedicated to the memory of Dr. Conflict of interest No conflict of interest is declared by authors. References 1. Primary vaginal melanoma: a critical analysis of therapy. Ann Surg Oncol. Weinstock MA. Malignant melanoma of the vulva and vagina in the United States: patterns of incidence and population-based estimates of survival.

Am J Obstet Gynecol. Primary malignant melanoma of the vagina. Eur J Gynaecol Oncol. Piura B. Management of primary melanoma of the female urogenital tract. Lancet Oncol. Arch Gynecol Obstet. Primary malignant melanoma of the vagina: a case report and review of the current treatment options.

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Primary amlanotic melanoma of the vagina. Vaginal malignant melanoma: a case report and literature review. Int J Gynecol Cancer. J Clin Oncol. Primary malignant melanoma of the vagina: case report and review of literature. Primary vaginal melanoma: thirteen-year disease-free survival after wide local excision and review of recent literature. Primary malignant melanoma of the vagina: long-term remission following radiation therapy.

Gynecol Oncol. Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. A clinicopathological study of malignant melanoma with special reference to atypical presentation.

Indian J Pathol Microbiol. Primary malignant melanoma of the vagina: a case report. Management of melanomas of the female genital tract. Curr Opin Oncol. Support Center Support Center.

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