Uterine cervical melanoma presenting with rapid progression detected by PET/CT
The patient was a 66-year-old woman who had been menopausal for 13 years, complaining of recent vaginal bleeding. Gynecologic examination found a small cervical polyp. The polypoid tumor was excised, measuring 1.7 × 1.7 × 1.5 cm in size. Microscopic examination revealed sheets or solid nests of epithelioid tumor cells with pleomorphic nuclei and scattered mitotic figures. The tumor cells were diffusely positive in staining for vimentin and S-100 protein. Some of the cells were also positive for HMB-45 (Fig. ). A diagnosis of malignant melanoma was made. Initial staging with magnetic resonance imaging (MRI) showed a vaginal tumor and an enlarged lymph node in the right part of the pelvis (Fig. a). Whole-body PET/CT was then performed, and revealed metabolic active lesions in the areas corresponding to those seen on the MRI (Fig. b). The patient thus received radical hysterectomy, a total vaginectomy, and pelvic lymphadenectomy. The final diagnosis was malignant melanoma of the uterine cervix with metastases to pelvic lymph nodes and vagina. Two months after the operation, without any further treatment, PET/CT identified a recurrence of metabolic active lesions in one of the abdominal para-aortic lymph node (Fig. a). Debulking surgery to remove the lymph node was performed and the lesion was proven to be metastatic. The patient then received radiotherapy targeting the para-aortic region. Three months after completion of radiotherapy, a pelvic MRI examination was negative. However, whole-body PET/CT demonstrated unsuspected multiple metastases that extensively involved the brain, right breast, both lungs, and lymph nodes of the right side of the neck, supraclavicular region, and abdominal cavity (Fig. b). Histological analysis found the massive tumor in her right breast to be a metastatic melanoma. The patient refused further management except for palliative radiotherapy targeting the brain.