PMC10148169_01
PMC10148169_02
magnetic resonance imaging of the prostate showing - A) T2-weighted indicating lesion in the peripheral zone (white line); B) apparent diffusion coefficient (ADC) indicating focal mild to moderate hypointensity in the peripheral zone (white line)
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F1
The lesion was equivocal with negative diffusion contrast enhancement (DCE) corresponding to a Prostate Imaging-Reporting and Data System score of three (PIRAD III) (Figure 1 (A,B)).
cystoscopy photo of pigmented lesion (arrow)
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F2
On cystoscopy, the urethra had a 1 x 0.5 cm melanomatous patch in the proximal bulbar urethral region and nodular pigmented growths in the prostatic fossa (Figure 2).
A) enlarged blue-black pelvic lymph nodes (arrow); B) cystoprostatectomy with urethra specimen
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F3
The patient underwent laparoscopic radical cystoprostatectomy with extended pelvic lymph node dissection, which, to our surprise, showed enlarged blue-black pelvic lymph nodes, which were not there initially in imaging (Figure 3A). Urethrectomy was done perineally, and the whole specimen was delivered into the abdomen in toto (Figure 3B).
histopathological photos showing - A) round nuclei tumor cells with prominent nucleoli and moderate cytoplasm, both intracellular and extracellular deposit of melanin pigment is seen [H&E,400X]; B) tumour cells with cytoplasmic positivity for HMB-45 [IHC,200X]
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F4
Immunohistochemistry (IHC) was positive for human melanoma black 45 (HMB-45) and melan-A (Figure 4 A,B).