대 한 방 사 선 의 학 회 지 1993 ; 29 (3) : 497~500 Journal of Korean Radiological Society, May, 1993

Malignant Melanoma of the Vagina: CT and MR Findings

Woo Kyung Moon, M.D., Seung Hyup Kim, M.D., Hyeong Joon Jeon, M.D., Man Chung Han, M.D.

Department 01 Radiology, Seoμ1 National Universψ College 01 Mediciηe

- Abstract-

We report CT and MR findings in two cases of p미naπ rnalignant melanoma of the vagina, one arising

from cervicovaginal junction mimicking squ킹nous cell carcinoma of the cervix and the other one recurring at

vagina after resection. Two cases of malignant melanoma had high-attenuation on CT and high signal intensity

on Tl-weighted MR images and enhanced well after gadopentetate c\imeglumine administration.

Index Words: Vagina, Magnetic resonance imaging 855.1214

Vagina, neoplasms 855.321

Vagin, melanoma 855.371

The Vagina is an infrequent site of primary

malignant neoplasm, and primaη vaginal melano­

ma is rare, with appro잉mately 150 cases being

reported in the literature (1 ,2). Although the

Computed tomography (CT) features of vaginal

melanoma have been described (3) , magnetic

resonance (MR) findings have not been previous­

ly reported. We report CT and MR findings in

two cases of malignant melanoma of the vagina, one arising from cervicovaginal junction rnirnick­

ing squ잉nous cell carcinoma of the cervix and

the other are recurring at vagina after the

resection of a vulvar melanoma.

CASE REPROTS

Case 1

A 65-year-이d postmenopausal woman pre­

sented with a 4-month history of vaginal bleed­

ing and dysuria. Gynecologic exarnination re­

vealed a 3 .5cm sized dark lesion in the uterine

cervIX.

CT of the pelvis showed an ovoid high-atten­

uation mass on the right side of uterine cervix

(Fig. la). No pelvic or paraaortic lymph node in­

volvement was seen. MR imaging was obtained

with a 0.5-T superconducting scanner (Supertec

5000; Goldstar, Seoul) and spin-echo techniques.

Tl-weighted axial image revealed an ovoid mass

at cervicovaginal juction with hypersignal

intersity which was 42% higher than that of the

gluteus muscIe (Fig. lb). The mass enhanced

moderately following adrninistration of gado­

pentetate dimeglurnine (Gd) . On T2-weighted

image, the signal intensity of the mass was in­

creased (Fig. lc). Bilateral salpingo-oophorecto­

my and total hysterectomy were performed.

There was a black ulcerofungating mass in the

upper vagina extending into the uterine cervix

(Fig. ld). The pathologic diagnosis was malignant

melanoma. The tumor involved full thickness of

the anterior vaginal wall and extended into the

이 논문은 1992년 9월 19일 접수하여 1992년 11월 2일에 채택되었음.

Received September 19, Accepted November 2, 1992

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Journal of Korean Radi이 ogical Society 1993; 29 (3) : 497~500

a b

c d

Fig. 1. A 65-year-old woman with a primary malignant melanoma of the vagina. a. Contrast-enhanced CT scan shows an ovoid high-attenuation mass (arrow) on the right side of uterine cer­VIX.

b. Tl -weighted (500/3이 앓i외 MR image shows a high signal intensity mass (arrow) involving anterior vaginal wall and right anterior aspect of uterine cervix. c. T2-weighted (2000/ 85) sagitt외 image shows an intermediate si밍lal intensity mass (arrows) at upper vagina. A round low signal intensity mass (open arrows) at uterine body represents a uterine myoma d . On hysterectomy specimen, a black ulcerofungating mass is seen at upper vagina extending into the cervix. M=myoma.

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cervix. Radiation therap was perfonned after the

surgery.

Case 2.

A 35-year-old nulliparous woman was

admitted with one-month history of vagin떠

bleeding. She had vulvectomy due to malignant

melanoma two years ago. Contrast-enhanced CT

shows a large vaginal mass with peripheral high­

and central low-attenuation (Fig. 2a). T1-weight­

ed 값i떠 MR image showed a mass with intenne­

diate signal intensity, which was 32% higher than

that of gluteus muscle, and with focal high si망lal

intensity areas (Fig. 2b). The mass occupied the

whole vaginal canal. T2-weighted image showed

a mass with increased signal intensity and con­

trast-enhanced T1-weighted image showed

heterogeneous enhancement of the mass (Fig.

2c). With the apparent evidences of pelvic lymph

nodes and urinary bladder invasion, chemothera-

Woo Kyung Moon , et al : Malignant Melanoma of the Vagina

a

~~~~nn~. b

DISCUSSION

Malignant melanomas of the female genit따

tract account for 3% of all malignant mel없lomas ，

、llÙvar melanomas being the most common (1 ,2).

Of these genital tract melanomas, only one-tenth

are primaπ melanomas of the vagina, which rep­

resent only 2.5% of all va밍n떠 malignancies (4) .

Our first case belongs to primary va밍n외 melano­

ma, but the second case is an example of vaginal

recurrence of surgically removed vulvar melano-

ma.

Malignant melanoma of the vagina is mainly a

disease of the postmenopausal woman, with 75%

of patients being over 50 years of age (1). Recur­

rent vaginal bleeding or discharge of recent

onset is the most common complaint. This symp­

tom can be related to superficial ulceration of

the mass. Melanoma m야 arise anywhere in the

vagina, with a predilection of the lower third (1).

c

Fig. 2. A 35-year-이d woman with vaginal recur­rence of a vulvar melanoma. a. Contrast-enhanced CT shows a large vagin띠 mass with peripher와 high-and central low-attenuation. b. Tl-weighted (600/ 30) image shows a large inter­mediate signal intensity vaginal mass with focal hyperintense areas (arrows). c. Contrast-enhanced Tl-weighted image shows heterogeneous enhancement of the mass.

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Journal of Korean Radi이 ogical Society 1993; 29 (3) : 497~500

As far as histogenesis is concemed (5), the

presence of m a1ignant melanoma of the cervix or

vagina may be accounted for by two facts: (1) the

presence of melanin-containing cells in 3.5% of

otherwise norma1 cervix. Their origin has been

discussed and severa1 theories proposed (epitheli­

a1, schwannian syncitium, neura1 crest migration):

(2) the recognition of benign pigmented lesion at

the ceπix or vagina (benign melanosis, blue

nevus, benign lentigo) . Ma1ignant melanoma

could arise de novo, or by m a1ignant transforma­

tion of a previously benign pigmented lesion.

For practic외 purposes, differentia1 diagnosis

from squ없nous cell carcinoma of the uterine cer­

vix is one of the most important guestions. On

T1-weighted MR imaging, the masses in our two

cases had increased signa1 intensities higher than

pelvic musc1es by 42% and 32%, respectively. On

T1-weighted image, the signa1 intensity of the

cervica1 mass was compared to that of the pelvic

musc1es in 10 patients with uterine cervica1 carci­

noma. The signa1 intensity ratio was 110.0 ::t 1 0.3%

(mean ::t standard deviation) (unpublished da때.

MR characteristics of melanoma have been

discussed in the context of metastatic intracrania1

melanoma and melanomas involving the eye (6).

These studies demonstrated that for intracrania1

melanotic and uvea1 melanomas the predominant

MR chracteristics were hyperintensity on T1-

weighted images and hypointensity on T2-

weighted images. These findings were attributed

to either the paramagnetism of stable free radi­

ca1s occurring in melanin or the methemoglobin

in hemorrhagic regions within the tumor. How­

ever, m a1ignant melanomas may have different

siga1 characteristics according to melanin concen­

tration and stage of hemorrhage (7,8).

A ma1ignant melanoma should be considered

when a vagina1 mass unusua11y high signa1 intensi­

ty on T1-weighted MR image.

REFERENCES

1. Levitan Z, Gordon AN , Kaolan AL , Kaufman RH.

Primary malignant melanoma of the vagina: re­

port of four cases and review of the literature.

Gynecol Oncol 1989; 33:85-90

2. Reid GC , Schmidt RW, Roberts JA, Hopkins MP ,

Barrett 앤， Morley GW. Primaη melanoma of the

vagina: a clinicopathologic analysis. Obstet

Gynecol1989; 74:190-199

3. Constant BO , Blake P. Primaπ malignant melano­

ma of the vagina. Br J Radiol 1989; 62:623-624

4. Lee RB , Buttoni L, Dhru K, Tamimi H. Malig­

nant melanoma of the vagina: a case report of

progression from pre-existing melanosis. Gynecol

Oncol 1984; 19:238-245

5. Pinedo F, Ingelmo JM , Miranda P, Garzon A,

Lopez J 1. Primary malignant melanoma of the

uterine cervix: case report and review of the liter­

ature. Gyecol Obstet Invest 1991; 31:121-124

6. Peyman GA, Mafee MR. Uveal melanoma and

similar lesions: the role of the magnetic resonance

imaging and computer tomography. Radi이 Clin

North Am 1987; 25 :471-486

7. Atlas SW, Grossman 젠， Gomori JN , et al. MR

imaging of intracranial metastatic melanoma. J

Comput Assist Tomogr 1987; 11:577-582

8. Woodurff WW J r. , Djang WT, McLendon RE ,

Heinz RE , 、Toorhees DR. Intracerebral malignant

melanoma: high-field strength MR imaging. Radi­

ology 1987; 16:209-213

〈국문 요약〉 질에 생긴 원발성 악성흑색종의 CT와 MR소견

서울대학교 의과대학 진단방사선과학교실

문우경·김 송협·전형 준·한만청

저자들은 질에 생긴 원발성 악성흑색종 2예의 CT와 MR 소견을 분석하였다. 1예는 질과 자궁경부의 경계부에서 생겨 자궁경부암과 혼동된 예이고， 다른 1예는 수술후 재발한 예이다. 2예 모두 CT에서는 고음영도의 질종괴였으며 MR에서는 Tl 강조영상에서 높은 신호강도를 보였고 조영증강이 잘 되었다.

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