PMC8051228_01
A) initial normal appearing CXR; B) metastasis evidenced by upper lobes nodular infiltrate and pleural effusion; this CXR was performed after 1 month of surgery; C) pelvic MRI reveals an ill-defined vulvovaginal tumour not involving the bladder, uterus or rectum; D) CT scan show right inguinal lymphadenopathy
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F1
The chest X-ray (CXR) was unremarkable (Figure 1A). Imaging (MRI) revealed a vulvovaginal tumour which pushed the uterus superiorly. It did not show bladder or rectal involvement (Figure 1C). Tomography (CT) showed pelvic lymph nodes metastasis (Figure 1D). The full blood count showed hemoglobin of 9.2 g/dl while the rest of the blood investigation was unremarkable. A CXR at this point showed upper lobes nodules and left pleural effusion in keeping with lung metastasis (Figure 1B).
A) ulcerated and multinodular tumour with focal labia majora; B) cut section show nodular, white-tan and hemorrhagic tumour; C) uninvolved epithelium; D) ulcerated epithelium with underlying nodular tumour; E) large, atypical cells with vesicular nuclei and prominent inclusion-like nucleoli; F) immunohistochemistry show tumour cells immunoreactive for Melan A
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F2
An ulcerated, multinodular and rubbery tumour measuring 90x50x25mm was received (Figure 2A, Figure 2B) with pelvic and inguinal lymph nodes for histopathological assessment. Microscopy showed a malignant nodular melanoma evidenced by an ulcerated tumour arranged in a nodular pattern without epithelial component (Figure 2C, Figure 2D). Intracytoplasmic melanin pigment was not seen (Figure 2E). The tumour cells were immunoreactive for melanin A (Figure 2F), HMB45 and S-100 protein.