Primary malignant melanoma of the vagina: A case report and review of literature
A 60 year old woman, P2 + 0, post-menopausal by 20 years, presented in gynecology department with the complaints of white discharge and recurrent small amount of bleeding per vagina for last 3 months. The patient was hypertensive, diabetic and had total abdominal hysterectomy with bilateral salpingo oophorectomy 20 years ago. Per speculum vaginal examination revealed, a brown colored, firm nodule of 1cm2 at lower 1/3rd postero lateral vaginal wall without any surrounding vaginal colour changes. Bilateral parametria were free and rectum was normal and there was no inguinal lymphadenopathy. Wide local excision biopsy (Free margin 1 cm) was done and sent for histopathological examinations. Unfortunately we lost follow up of the patient for next six weeks and she returned with histopatological report of lesion of malignant melanoma of vaginal mucosa. At this point, her vaginal examination revealed healing of the wound site with presence of indurations and diffuse black colour change of both lower 1/3rd of anterior and posterior vaginal wall []. MRI pelvis revealed a 3 × 1.9 × 1.6 cm mass in the posterolateral vagina with bilateral reactive lymph nodes in inguinal region.\nMetastatic work up was done. PET scan revealed an ill-defined soft tissue mass in mid vagina involving left lateral wall (1.5 × 1.2 cm) standard uptake value (SUV = 5.6) with perilesional fat plane preserved. Irregular linear uptake of 18 fluro deoxy glucose (FDG) (SUV 9.7) was found along left vaginal wall with no obvious CT scan lesion. Few subcentimeter lymph nodes (SUV 2.3) were also present in both inguinal and external iliac region.\nPatchy linear uptake (SUV 6.0) was found in right rectus abdominis muscle, with bilateral subcarinal lymph nodes (SUV 6.2) and another lesion was found in the infraumbilical region. However, definitive evidence of metastasis was not histopathologically confirmed by FNAC or excision biopsy.\nThe patient was treated with external beam radiotherapy (40 Gy in 10 fractions; 2 fractions per week) with palliative intent to the tumor bed, followed chemotherapy with six cycles of Temozolamide, 250 mg orally for 5 days, per cycle. The patient is alive after 1 year and under follow up [].