Department of Urology, Faculty of Medicine, Miyazaki University, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
Department of Pathology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan.
J Med Case Rep. 2024 Aug 28;18(1):396. doi: 10.1186/s13256-024-04716-8.
Metastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary tract.
Case 1: an 86-year-old Japanese man was diagnosed with a small bladder tumor by computed tomography scan during post operative follow-up of malignant melanoma in the choroid of the left eye. Cystoscopy revealed black, nonpapillary tumors, suggesting metastatic malignant melanoma. Because no apparent invasive growth to muscle layer was observed by magnetic resonance imaging, transurethral resection was performed. Pathological appearance was compatible with metastatic malignant melanoma. No recurrence in urinary tract was observed; however, multiple liver metastasis was diagnosed at 3 months after surgery. Case 2: a 57-year-old Japanese man was diagnosed with right hydronephrosis due to ureteral tumor. He had a past history of subungual malignant melanoma to the left thumb 2 years prior to his visit. Right nephroureterectomy was performed, and pathological evaluation revealed metastatic malignant melanoma. He revisited 2 years later due to dysuria, and a large bladder tumor was revealed by ultrasound. Cystoscopy showed black-colored nonpapillary tumor, suggesting malignant melanoma. Total cystectomy was recommended; however, the patient withheld consent. Therefore, we performed transurethral resection. The resulting pathological finding was compatible with metastatic malignant melanoma without invasion to muscle layer. He remained free from local recurrence and metastasis for 22 years after surgery.
We successfully performed metastasectomy for bladder and ureteral metastases without recurrence in the urinary tract. Long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have the potential to improve survival.
据回顾性分析单一中心的研究结果显示，有明确转移灶并接受以治愈为目的的转移灶切除术的胃肠道转移患者，其总体生存率得到了改善。然而，对于泌尿系统转移灶，尚无明确的手术切除获益证据。
病例 1：一名 86 岁的日本男性在左眼脉络膜恶性黑色素瘤术后随访中，通过计算机断层扫描检查发现小膀胱肿瘤。膀胱镜检查显示黑色、非乳头样肿瘤，提示转移性恶性黑色素瘤。由于磁共振成像未观察到明显的肌层浸润性生长，因此进行了经尿道切除术。病理表现符合转移性恶性黑色素瘤。未观察到泌尿系统复发；然而，术后 3 个月诊断出多发肝转移。病例 2：一名 57 岁的日本男性因输尿管肿瘤导致右侧肾积水。他在就诊前 2 年前曾有左拇指甲下恶性黑色素瘤病史。行右肾输尿管切除术，病理评估提示转移性恶性黑色素瘤。2 年后因排尿困难复诊，超声显示膀胱内有一个大肿瘤。膀胱镜检查显示黑色、非乳头样肿瘤，提示恶性黑色素瘤。建议行全膀胱切除术，但患者拒绝。因此，我们进行了经尿道切除术。病理结果符合无肌层浸润的转移性恶性黑色素瘤。术后 22 年，患者未出现局部复发和转移。
我们成功地对膀胱和输尿管转移灶进行了转移灶切除术，且泌尿系统未复发。病例 2 观察到了较长的无复发生存期。完全切除恶性黑色素瘤转移灶可能具有改善生存的潜力。
