Nai Gisele Alborghetti, Bazan Andressa, Rocha Caroline Andrade, Nagy Juliana Souza, Campos Isadora Tanaka
Faculdade de Medicina, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil.
Rev Bras Ginecol Obstet. 2018 Mar;40(3):163-167. doi: 10.1055/s-0038-1624578. Epub 2018 Feb 23.
Melanomas of the female genital tract may occur in the vulva, the vagina, the ovary or the cervix. Pregnancy has been considered an aggravating factor in the evolution and prognosis of melanoma. A 35-year-old female presented with vaginal bleeding 2 months after a term cesarean delivery. An endovaginal ultrasound revealed a lesion in the uterine cervix. The pathological report revealed a small round-cell neoplasm, and the immunohistochemistry confirmed the diagnosis of malignant melanoma. A positron emission tomography revealed an expansive hypermetabolic lesion centered on the cervix, and hypermetabolic lesions in the liver and right kidney. Non-surgical treatment was provided, with biochemotherapy followed by ipilimumab and nivolumab. The patient died one year later. Postpartum vaginal bleeding, even if late-onset, should be investigated, as it may be a pregnancy-associated malignant melanoma, which has a poor prognosis.
女性生殖道黑色素瘤可发生于外阴、阴道、卵巢或宫颈。妊娠被认为是黑色素瘤病情发展及预后的一个加重因素。一名35岁女性在足月剖宫产术后2个月出现阴道出血。经阴道超声检查发现子宫颈有一个病变。病理报告显示为小圆细胞肿瘤，免疫组化确诊为恶性黑色素瘤。正电子发射断层扫描显示以宫颈为中心的一个扩展性高代谢病变，以及肝脏和右肾的高代谢病变。给予了非手术治疗，先进行生物化疗，随后使用伊匹单抗和纳武单抗。患者一年后死亡。产后阴道出血，即使是迟发性的，也应进行检查，因为它可能是与妊娠相关的恶性黑色素瘤，预后较差。
