PMC9267710_01
Clinical image taken during examination under anaesthesia.
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A detailed gynaecological examination showed a large, dark-blue mass protruding around 3 cm out of the vagina (Fig. 1) and speculum examination visualized it arising from the anterior vaginal wall.
Pelvic MRI (T1 axial view) showing a large mass in the vagina. The lesion demonstrates an elevated signal on T1, which is common for melanomas.
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Contrast-enhanced magnetic resonance imaging (MRI) of the pelvis showed a 3.2x1.7x2.6 cm lesion in the perineum (Fig. 2) along with a 2.3x1.4 cm right inguinal lymph node.
Maximum imaging projection (MIP) of a PET/CT scan showing the vaginal mass (red arrow) and right inguinal lymph node (blue arrow). The unlabelled, high activity area in the pelvis represents the bladder, which is a normal finding.
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A whole-body positron emission tomography (PET) result corroborated the MRI findings (Fig. 3).
Histopathology of the vaginal mass biopsy.
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The vaginal mass biopsy (Fig. 4) was reported as invasive melanoma with a Breslow's thickness of 4.5 mm, no ulceration, invasion present at the margin, a mitotic rate of 3/hpf (high power field), no microsatellitosis, and no lymphovascular invasion, neurotropism or tumour regression.