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Primary Melanoma of the Bladder at Puerperium

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Primary Melanoma of the Bladder at Puerperium ISSN: 2469-5742 Rubio et al. Int Arch Urol Complic 2020, 6:073 DOI: 10.23937/2469-5742/1510073 Volume 6 | Issue 1 International Archives of Open Access Urology and Complications CASE REPORT Primary Melanoma of the Bladder at Puerperium: Case Report Rubio Galisteo JM1*, Gomez Gomez E1, Valero Rosa J1, Salguero Segura J1, Pineda Reyes B2, Gonzalez T3, Barbudo Merino J4, Ruiz Garcia JM1 and Requena Tapia MJ1 1Urology Department, Hospital Universitario Reina Sofia, Spain 2Ginecology Department, Hospital Universitario Reina Sofia, Spain 3 Check for Pathological Anatomy Department, Hospital Universitario Reina Sofia, Spain updates 4Emergency Department, Hospital Universitario Reina Sofia, Spain *Corresponding author: Rubio Galisteo JM, Urology Department, Hospital Universitario Reina Sofía, Av Menendez Pidal S/N, UGC Urología, Córdoba, CP: 14004, Spain, Tel: +3460-004-5566 of urinary bladder in a 39-years-old postpartum wom- Abstract an. Primary malignant melanoma of the urinary bladder is a sporadic disease and very little described in the literature. Case Presentation A 39-years-old female at the end of her pregnancy without previous history of skin disease was presented with hema- A healthy 39-years-old female is presented at the turia after cesarean and with constitutional syndrome. After end of her first pregnancy. The patient gives a history of the study, the patient was diagnosed with metastatic blad- 10 kg lost at the last months, and urinary tract infection der melanoma. Other locations of primary injury were ruled out. The patient died a month and a half after the diagnosis. treated with antibiotics with a urine culture positive to E. coli one month earlier. The patient is admitted to the Abbreviations hospital with contractions in context clinic to birthing. CT Scan: Computed Tomography Scan; TUR: Transure- At that moment, the patient present general discom- thral Resection fort, dyspnea, tachycardia and sweating. Some hours later, it’s necessary to practice an urgent caesarean for Introduction loss of fetal wellbeing with the necessity of urinary cath- Malignant melanoma of urinary bladder is a spo- eterization showing gross hematuria. After caesarean radic disease, very little described in the literature. and the persistence of dyspnea, a chest X-ray is taken Approximately only about 50 cases have been report- showing cottony infiltrates, so a computed tomography ed throughout history. This histological type is part of scan is taken viewing an excrescence lesion in bladder the group of tumours of mesenchymal origin. These suggestive of bladder cancer with multiple metastatic tumours are accounting for 0.2 to 5% of all bladder tu- lesions in the liver, spleen, left adrenal, presacral re- mours. The bladder localization is an uncommon region gion, peritoneum and the retroperitoneal region as well for melanoma, being only 0.2% of all melanomas. It be- as in axial skeleton and pulmonary parenchyma (Figure longs to the mucosal melanomas; these tumours gen- 1). erally carry a worse prognosis than those arising from At the moment of birth, the child was healthy with cutaneous sites. In general, patients diagnosed with an APGAR test of 7/10, and no other disease expression mucosal melanomas are older, with a median age of 70 appeared after the cesarean. years [1-6]. To the findings in CT scan, it is decided in commit- We present a case of primary malignant melanoma tee realization of transurethral resection (TUR) and bi- Citation: Rubio GJM, Gomez GE, Valero RJ, Salguero SJ, Pineda RB, et al. (2020) Primary Melanoma of the Bladder at Puerperium: Case Report. Int Arch Urol Complic 6:073. doi.org/10.23937/2469- 5742/1510073 Accepted: June 17, 2020: Published: June 19, 2020 Copyright: © 2020 Rubio GJM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Rubio et al. Int Arch Urol Complic 2020, 6:073 • Page 1 of 4 • DOI: 10.23937/2469-5742/1510073 ISSN: 2469-5742 A A B B C Figure 2: A) HMB45 positive; B) Melan A2 positive; C) S100 positive. Figure 1: A) Cottony infiltrates at X-Ray; B) TC scan show- ing bladder lesion and metastatic lesions at liver. was decided to initiate chemotherapy treatment. On- cology department started the management by sub- opsies for etiologic diagnosis. At TUR, it was evidenced mitting the patient to be included in a clinical trial with by brown excrescence bladder lesion appearance. Mi- Nivolumab, but it was not approved, so therapy with croscopic after study shows spindle cell tumour prolif- Temozolomide was started. eration with areas of necrosis tested positive for S-100, After the treatment was started, the patient under- Melan-A and HMB-45 (Figure 2). went respiratory failure and right ventricular failure as After the microscopic study, the patient was studied well as the progression of the disease, requiring hospital by the dermatology department without finding any admission with subsequent deterioration, ending the malignant skin lesions. patient’s death one and a half months after the diag- nosis. The BRAF study was negative. The extension study was completed with skull CT scan finding clivus lesions All decision and management of the patient were and other locations. made under the express consent of the patient. Our patient was presented in an oncology commis- Primary bladder melanoma is an infrequent entity; sion to determinate the best treatment option, and it the most common is the appearance of bladder melano- Rubio et al. Int Arch Urol Complic 2020, 6:073 • Page 2 of 4 • DOI: 10.23937/2469-5742/1510073 ISSN: 2469-5742 ma as a metastatic disease from another location. It has modulating mechanism. It is established that the loss of been postulated as a possible aetiology of this histolo- certain HLA can contribute to the passage of malignant gy the origin of these cells at the neural crest and the cells through this barrier. presence of these in the bladder as the remains after In our case, the child was born without any sign of migration of these cells [7,8]. disease, and his evolution from his birth has been ac- Clinically, the most common symptom and the sign cording to standard parameters. of presentation is hematuria as in the rest of bladder Tellez, et al. suggest that pregnancy significantly tumours. Other symptoms include urinary tract infec- affects the results of melanoma; it has even been de- tion, symptoms of renal colic, low urinary tract symp- scribed that melanoma associated with pregnancy is as- toms, etc. There is a case published by Lamichhane and sociated with up to a 56% higher risk of mortality. This Dhakal in which the first symptom presented by the pa- evidence is further supported by some studies that sug- tient was acute urinary retention [7]. gest that pregnancy results in reduced antitumor immu- For diagnosis, Ainsworth establishes in 1976 specific nity and increased tumour lymphangiogenesis [14,16]. criteria for the correct definition of bladder melanoma. These include (1) Careful physical examination includ- Conclusions ing the skin with Wood’s light together with a detailed Malignant melanoma of urinary bladder is a sporadic history to exclude cutaneous melanoma, (2) Exclusion disease. Its diagnose is difficult, and its late diagnosis is of visceral melanoma following exhaustive evaluation, frequent. Considering the diagnosis of primary bladder (3) Pattern of recurrence consistent with primary mel- melanoma, it is essential to rule out other locations of anoma of urinary bladder and (4) Histologically proved more common origin. Multidisciplinary management is primary atypical melanocytes [9,10]. crucial for the correct treatment of the patient. In the treatment, numerous techniques have been Conflict of Interests described in the literature, but it is crucial to evaluate The authors declare that they have no conflict of in- metastatic workup before commencing the aggressive terests. treatment option. Transurethral resection, partial cystectomy, radical Acknowledgement cystectomy, chemotherapy and radiation therapy have All authors share equal responsibility for its content been used to treat bladder melanoma. It has been pos- and agree with the submission in its present format, tulated that radical surgery for localized lesions is the and the material is original research. reference treatment. In our case, it is a disseminated disease; surgery alone was raised as a diagnostic meth- References od to shed information about the histology of bladder 1. Ainsworth AM, Clark WH, Mastrangelo M, Conger KB injury [11-13]. (1976) Primary malignant melanoma of the urinary bladder. Cancer 37: 1928-1936. Bladder melanoma prognosis is poor; to date, very 2. Bhutani N, Kajal P, Pawar D (2017) Primary malignant mel- little of the patients survived more than three years de- anoma of the female urethra: Report of a rare neoplasm of spite radical treatment [9,10]. the urinary tract. Int J Surg Case Rep 41: 319-322. It is rare to find mutation on BRAF V600E in the cases 3. Chang AE, Karnell LH, Menck HR (1998) The National can- of mucosal melanoma, although the literature describes cer data base report on cutaneous and noncutaneous mel- anoma: A summary of 84,836 cases from the past decade. the rise of the levels of mutated BRAF at urinary bladder The American college of surgeons commission on cancer melanoma. In our case, the study about mutated BRAF and the American cancer society. Cancer 83: 1664-1678. was negative, but maybe more information about mela- 4. El Ammari JE, Ahallal Y, El Fassi MJ, Farih MH (2011) noma should be found to conclude this [14]. Primary malignant melanoma of the urinary bladder. Case Our case shows a particular scene; the patient was Rep Urol 2011. a pregnant woman. Although rare, cases have been de- 5.
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