Wicaksono Bagas Satriyo, Aditiyono Aditiyono, Marlina Dina, Utomo Aditya, Adriansyah Putri Nadhira Adinda, Novrial Dody
Department of Obstetrics and Gynecology, Padjadjaran University, Bandung, West Java, Indonesia.
Department of Obstetrics and Gynecology, Soedirman Jenderal University, Purwokerto, Central Java, Indonesia.
Am J Case Rep. 2025 Jan 10;26:e944972. doi: 10.12659/AJCR.944972.
BACKGROUND Vulvar melanoma during pregnancy is exceptionally rare. Hormonal and immunological changes in pregnancy have raised concerns about the potential for accelerated melanoma progression and poorer maternal outcomes. This case report describes an unusual presentation of vulvar melanoma in a pregnant patient, which rapidly progressed despite previous treatments, but resulted in a favorable fetal outcome. CASE REPORT A 40-year-old G3P2A0 woman at 28 weeks of gestation, with a history of vulvar malignant melanoma diagnosed 3 years prior, presented with sudden abdominal pain and hematuria. She had previously received 6 courses of chemotherapy. Physical examination revealed a 3-cm mass in the right vulva, while ultrasonography detected a hyperechoic solid mass in the cervix and elevated LDH levels. Given the advanced disease, the medical team proceeded with a cesarean hysterectomy, colpotomy for uterine corpus involvement, and bladder repair due to an iatrogenic laceration. Histopathological findings confirmed metastatic vulvar melanoma in the cervix and uterine corpus. The pregnancy was terminated at 27 weeks due to the progression of grade IV melanoma, but the neonate was delivered in stable condition. Unfortunately, the patient died 1 month after the operation. CONCLUSIONS This case underscores the potential for aggressive melanoma progression during pregnancy, likely exacerbated by physiological changes, yet highlights a successful fetal outcome. While chemotherapy can adversely affect the reproductive system and may lead to infertility, this patient was able to conceive, and the case illustrates the complex interplay of pregnancy and cancer progression.
背景 孕期外阴黑色素瘤极为罕见。孕期的激素和免疫变化引发了人们对黑色素瘤进展加速及孕产妇预后较差可能性的担忧。本病例报告描述了一名孕妇外阴黑色素瘤的不寻常表现，尽管此前接受过治疗，但病情仍迅速进展，不过胎儿结局良好。病例报告 一名40岁、孕3产2、流产0次的女性，孕28周，有3年前诊断为外阴恶性黑色素瘤的病史，出现突发腹痛和血尿。她此前接受过6个疗程的化疗。体格检查发现右侧外阴有一个3厘米的肿块，而超声检查在宫颈发现一个高回声实性肿块，乳酸脱氢酶水平升高。鉴于疾病已进展，医疗团队进行了剖宫产子宫切除术、因子宫体受累行阴道切开术以及因医源性撕裂伤进行膀胱修复。组织病理学检查结果证实宫颈和子宫体有转移性外阴黑色素瘤。由于IV级黑色素瘤进展，妊娠在27周时终止，但新生儿出生时情况稳定。不幸的是，患者术后1个月死亡。结论 本病例强调了孕期黑色素瘤侵袭性进展的可能性，可能因生理变化而加剧，但也突出了胎儿的良好结局。虽然化疗可能会对外生殖系统产生不利影响并可能导致不孕，但该患者能够受孕，本病例说明了妊娠与癌症进展之间复杂的相互作用。
