Hasumi K, Sakamoto G, Sugano H, Kasuga T, Masubuchi K
Cancer. 1978 Dec;42(6):2675-86. doi: 10.1002/1097-0142(197812)42:6<2675::aid-cncr2820420624>3.0.co;2-g.
Four cases of primary malignant melanoma of the vagina in women aged 23, 44, 51 and 65 years are presented. In these 4 cases, thorough clinical and postmortem examinations ruled out the possibility of a primary melanoma elsewhere. The primary tumors showed exophytic growth with superficial ulceration. Three of the melanomas arose from the middle third of the vagina and one from the upper third. Melanin was visible in sections stained with hematoxylin and eosin in 3 of the tumors. In the other one, the first biopsy failed to reveal melanin. However, the second biopsy performed following irradiation showed abundant melanin pigment. Electron microscopic examination of 3 tumors revealed premelanosomes and melanosomes in the tumor cells, thus confirming the diagnosis. Two neoplasms showed atypical histologic features, and only the presence of melanin enabled us to make diagnosis of malignant melanoma. One melanoma was associated with an adjacent widespread intraepithelial component of superficial spreading type indicating its probable mode of origin. All 4 patients died of widespread metastases within 13 months after initial treatment. These 4 cases, in which clinical diagnosis was confirmed by thorough autopsy, strongly indicate that malignant melanoma can arise directly from the vagina.
本文报告了4例原发性阴道恶性黑色素瘤病例，患者年龄分别为23岁、44岁、51岁和65岁。在这4例病例中，全面的临床和尸检排除了其他部位原发性黑色素瘤的可能性。原发性肿瘤呈外生性生长，伴有浅表溃疡。其中3例黑色素瘤起源于阴道中1/3段，1例起源于上1/3段。在3例肿瘤的苏木精-伊红染色切片中可见黑色素。另一例中，首次活检未发现黑色素。然而，放疗后的第二次活检显示有大量黑色素沉着。对3例肿瘤进行电子显微镜检查，发现肿瘤细胞内有前黑素小体和黑素小体，从而确诊。2例肿瘤表现出非典型组织学特征，仅黑色素的存在使我们能够诊断为恶性黑色素瘤。1例黑色素瘤与相邻的广泛浅表扩散型上皮内成分相关，提示其可能的起源方式。所有4例患者在初始治疗后13个月内均死于广泛转移。这4例病例经全面尸检证实临床诊断，有力地表明恶性黑色素瘤可直接起源于阴道。
