D. Dealberti, David Bosoni, Federica Spissu, Carla Pisani, Corinna Pizio, Luigi Nappi, F. Sorrentino, S. Carlucci, G. Stabile
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We present the first case in the literature of primary malignant melanoma of the endocervix diagnosed by outpatient hysteroscopy and we have performed a narrative review of the literature on PubMed, Scopus and Web of Science from 1980 to December 2023, identifying 137 cases. The most common initial symptom was vaginal bleeding in 82.8% of cases, and 84.8% of patients were menopausal at the time of diagnosis. The first diagnostic modality was biopsy in 67.7%; 90% of patients underwent surgery and 64.5% of the deaths occurred within the first 12 months after diagnosis. Primary malignant melanoma of the cervix is extremely rare and difficult to diagnose at an early stage which is due to the aggressiveness of the disease and the non-specificity of the symptoms. To improve survival, early diagnosis is essential and hysteroscopy could be a useful tool in achieving it. 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引用次数: 0
摘要
粘膜恶性黑色素瘤的发病率很低,只有 2% 的患者被确诊为妇科恶性黑色素瘤。原发性宫颈恶性黑色素瘤的诊断往往具有挑战性。临床表现与其他恶性宫颈肿瘤相似,通常伴有异常出血或分泌物。由于恶性黑色素瘤的罕见性,细胞学等宫颈筛查检查往往无法检测出恶性黑色素瘤,因此对病灶进行组织学评估至关重要。治疗通常以皮肤恶性黑色素瘤的治疗方案为基础。我们对1980年至2023年12月PubMed、Scopus和Web of Science上的文献进行了叙事性回顾,共发现137个病例。82.8%的病例最常见的初始症状是阴道出血,84.8%的患者在确诊时已绝经。67.7%的患者的第一诊断方式是活组织检查;90%的患者接受了手术,64.5%的患者在确诊后的头12个月内死亡。宫颈原发性恶性黑色素瘤极为罕见,而且很难在早期诊断,这是因为该病具有侵袭性,症状也没有特异性。为了提高存活率,早期诊断至关重要,而宫腔镜检查则是实现这一目标的有效工具。关键是要提高妇科医生对宫颈原发性恶性黑色素瘤的重视,在出现可疑症状时也要进行诊断性宫腔镜检查。
Primary Malignant Melanoma of The Endocervix Uteri and Outpatient Hysteroscopy as a Diagnostic Tool: Case Report and Literature Overview
Mucosal malignant melanoma has a low incidence and only 2% are diagnosed in the gynecological tract. Diagnosis of primary cervical malignant melanoma is often challenging. The clinical presentation mimics other malignant cervical tumors, usually with abnormal bleeding or discharge. Cervical screening tests, such as cytology, often fail to detect malignant melanomas because of the rarity of the disorder, and histological evaluation of lesions is of paramount importance. The treatment is often based on regimens used for cutaneous malignant melanoma. We present the first case in the literature of primary malignant melanoma of the endocervix diagnosed by outpatient hysteroscopy and we have performed a narrative review of the literature on PubMed, Scopus and Web of Science from 1980 to December 2023, identifying 137 cases. The most common initial symptom was vaginal bleeding in 82.8% of cases, and 84.8% of patients were menopausal at the time of diagnosis. The first diagnostic modality was biopsy in 67.7%; 90% of patients underwent surgery and 64.5% of the deaths occurred within the first 12 months after diagnosis. Primary malignant melanoma of the cervix is extremely rare and difficult to diagnose at an early stage which is due to the aggressiveness of the disease and the non-specificity of the symptoms. To improve survival, early diagnosis is essential and hysteroscopy could be a useful tool in achieving it. It is crucial to increase the attention of gynecologists on primary malignant melanoma of the cervix to also perform a diagnostic hysteroscopy in case of doubtful symptoms.