Obstet Gynecol Sci.  2019 Jul;62(4):290-293. 10.5468/ogs.2019.62.4.290.

The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding

• Park YH
• Byun JM
• Cho HJ
• Jeong DH
• Kim YN
• Park HR
• Lee KB
• Sung MS

• KMID: 2451660
• DOI: http://doi.org/10.5468/ogs.2019.62.4.290

Abstract

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

Keyword

Vaginal bleeding; Angiomatoid Spitz nevus; Melanoma

MeSH Terms

Adult
Diagnosis
Female
Gynecological Examination
Humans
Medical Overuse
Melanoma
Nevus, Epithelioid and Spindle Cell*
Nevus, Pigmented
Uterine Hemorrhage*
Vagina

Figure

• 

  Fig. 1 Laparoscopic images of the lesion. After laparoscopic hysterectomy, the vaginal mass (blue arrow) visible through the vaginal orifice. Gross examination showing a 2×2×1-cm mass with abundant blood vessels on the surface of the posterior upper part of the vagina.

• 

  Fig. 2 Pathologic findings. (A) Dermis with hypercellular epithelioid melanocytes and variable sized vessels (hematoxylin and eosin [H&E] stain, ×200). Inlet: cohesive clusters of uniform round tumor cells with scant cytoplasm, minimal nuclear pleomorphism, and indistinct nucleoli (H&E stain, ×400). (B) Thin to thick bands of hyalinized collagen throughout the dermis. Prominent endothelial cells protruding into the vessels. (C) Diffuse positivity of the nevus cells for S100 (S100 stain). (D) CD34 expression is indicative of prominent vasculature (CD34 stain).

Reference

1. Diaz-Cascajo C, Borghi S, Weyers W. Angiomatoid Spitz nevus: a distinct variant of desmoplastic Spitz nevus with prominent vasculature. Am J Dermatopathol. 2000; 22:135–139.

2. Spitz S. Melanomas of childhood. Am J Pathol. 1948; 24:591–609.

3. Fabrizi G, Massi G. Angiomatoid Spitz naevus: a close simulator of regressing malignant melanoma. Br J Dermatol. 2001; 145:845–846.

4. Tetzlaff MT, Xu X, Elder DE, Elenitsas R. Angiomatoid Spitz nevus: a clinicopathological study of six cases and a review of the literature. J Cutan Pathol. 2009; 36:471–476.

5. Gökaslan H, Sişmanoğlu A, Pekin T, Kaya H, Ceyhan N. Primary malignant melanoma of the vagina: a case report and review of the current treatment options. Eur J Obstet Gynecol Reprod Biol. 2005; 121:243–248.

6. Al-Shraim MM. Angiomatoid giant cellular blue nevus of vaginal wall associated with pregnancy. Diagn Pathol. 2011; 6:32.

7. Magro CM, Crowson AN, Mihm MC. Unusual variants of malignant melanoma. Mod Pathol. 2006; 19:Suppl 2. S41–S70.

8. Androutsopoulos G, Terzakis E, Ioannidou G, Tsamandas A, Decavalas G. Vaginal primary malignant melanoma: a rare and aggressive tumor. Case Rep Obstet Gynecol. 2013; 2013:137908.