Obstet Gynecol Sci.  2018 Jul;61(4):524-528. 10.5468/ogs.2018.61.4.524.

Primary malignant melanoma of the uterine cervix treated with pembrolizumab after radical surgery: a case report and literature review

• Kim MS
• Choi CH
• Kim TJ
• Lee JW
• Lee J
• Bae DS
• Kim BG

• KMID: 2439727
• DOI: http://doi.org/10.5468/ogs.2018.61.4.524

Abstract

Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.

Keyword

Melanoma; Pembrolizumab; Antibodies, monoclonal, humanized; Uterine Cervical Neoplasms

MeSH Terms

Adult
Antibodies, Monoclonal, Humanized
Biopsy
Cervix Uteri*
Diagnosis
Female
Gynecological Examination
Humans
Hysterectomy
Immunotherapy
Lung
Lymph Node Excision
Melanoma*
Prognosis
Rare Diseases
Uterine Cervical Neoplasms
Vagina
Vaginal Discharge
Antibodies, Monoclonal, Humanized

Figure

• 

  Fig. 1 (A) Pelvis magnetic resonance imaging showing melanoma of the cervix (arrow). The lesion was 9.5×7.5 cm and had invaded the upper vagina. (B) A large hypermetabolic mass with increased fluorodeoxyglucose uptake of maximum standardized uptake value (SUVmax=17.1) in the uterine cervix (large arrow). Bone metastases were observed with increased fluorodeoxyglucose uptake in T4 (SUVmax=8.6) and L5 (SUVmax=6.7) spins (large arrowhead). Right common iliac, bilateral internal iliac, and right perirectal area lymph node metastases were observed (small arrow). Small pulmonary nodules suspected because pulmonary metastases were observed in the right middle and left lower lobes of the lungs. Multiple pleural nodules suspected because pleural metastases were observed in the left lung (small arrowhead).

• 

  Fig. 2 (A) Infiltrative tumor cells (hematoxylin and eosin, magnification ×200). (B-D) Immunohistochemical positivity for Melan-A, HMB45, and Ki-67 (magnification ×200). (E) Gross features of the mass showing melanoma of cervix: the lesion is located in the posterior portion of the cervix, approximately 7×7 cm in size, and contains a black portion (arrow). A leiomyoma of about 4×4 cm is located in the uterine body (arrowhead).

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