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Journal of Urology and Research
Cite this article: Lamichhane N, Dhakal HP (2016) Melanoma of Urinary Bladder Presented as Acute Urine Retention. J Urol Res 3(3): 1054.
*Corresponding author
Nirmal Lamichhane, Department of Surgical
Oncology, B P Koirala Memorial Cancer Hospital,
Bharatpur Municipality ward no 7, Chitwan, Nepal, Tel:
9855046811; Email:
Submitted: 13 March 2016
Accepted: 06 April 2016
Published: 09 May 2016
ISSN: 2379-951X
Copyright
© 2016 Lamichhane et al.
OPEN ACCESS
Keywords
•Melanoma
•Urinary bladder
•Cystectomy
•Prognosis
Case Report
Melanoma of Urinary Bladder
Presented as Acute Urine
Retention
Nirmal Lamichhane1* and Hari P Dhakal2
1Department of Surgical Oncology, B. P. Koirala Memorial Cancer Hospital, Nepal
2Pathology, B. P. Koirala Memorial Cancer Hospital, Nepal
Abstract
This report is of a 50-year-old man with a rare urinary bladder melanoma.
He presented with hematuria followed by bladder outlet obstruction at the time of
presentation. Ultrasonogram of the pelvis revealed a mass in the bladder outlet,
suggestive of enlarged prostate. Suprapubic cystostomy was then performed.
Subsequent transvesical exploration revealed a dark coloured mass at the outlet of
bladder, which on histopathology conrmed to be melanoma. After ruling out other
possible primary sites, he underwent radical cysto-urethrectomy with urinary diversion.
Disease was conrmed with immunohistochemistry. Patient died after 3 months with
bilateral lung metastasis.
ABBREVIATIONS
UB: Urinary Bladder
INTRODUCTION
Malignant melanoma of urinary bladder is a very rare entity
to report a primary melanoma of the urinary bladder in 1942,
and Su et al. reported the next case in 1962 [1,2]. Approximately
50 patients with this tumour have been reported in the literature
shown by Medline search. This is a nonurothelial/mesenchymal
tumour of the urinary bladder. These tumors are accounting for
1% to 5% of all bladder tumours. The percentage of melanoma
among this is not well reported [3,4]. The skin is the commonest
site for melanoma and common site for visceral/mucosal
present with this disease at the B. P. Koirala Memorial Cancer
Hospital among the operations of urinary bladder performed till
this date [5]. Though the treatment was aggressive, prognosis is
not comparable with commonest skin melanoma.
CASE PRESENTATION
A 50- years old male presented with total hematuria and
to pass urine for one day. Catheterization at local hospital was
failed. At the time of presentation at emergency room, the urinary
bladder was full up to umbilicus. The urinary catheterization was
re-tried but was not successful. Sonography was performed which
showed enlarged prostate and distended bladder. Suprapubic
cystostomy was performed that comforted the patient.
On asking, he had voiding type lower urinary tract symptoms
for 2 and half months, but had no haematuria or fever. He had
lost four kilograms of weight in this period. He had decreased
appetite but was moving normal bowel motions. He was a
smoker and social drinker. There was no history of trauma to
the lower abdomen or perineum. He also had not got any skin or
ocular lesions. The patient was not allergic to any medication. His
family history was noncontributory. On examination he was well
oriented, average in built and cooperative. Pallor was present. No
was in situ and draining clear urine. There were some clots at
the urethral meatus. On digital rectal examination, the prostate
obvious skin or ocular lesions were visible.
His hemoglobin was 9.9 gm/dl. Ultrasound of the abdomen
showed enlarged median lobe of prostate. Considering an
enlarged prostate, transurethral resection was planned. Intra-
neck, major bulk of which is arising at the trigone and growing
the tumour and looking normal. The tumour was resected, the
mucosa of the prostatic urethra also looked dark in colour and
removed was sent for frozen section histopathology analysis
which was suggestive of melanoma. We concluded the surgery
with a urinary catheter.
The diagnosis later in conventional H & E stain was melanoma
(Figure 1). Immunohistochemistry performed in the same
tissue was positive for HMB-45 (Figure 2) and S-100 (Figure 3)
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neck lesion was melanoma with muscle invasion and the iliac
nodes were also harbouring the metastatic melanoma cells.
Patient developed extensive bilateral pulmonary metastasis and
survived only 3 months after diagnosis.
DISCUSSION
Primary melanoma of urinary bladder is a rare neoplasm.
The histogenesis of primary bladder melanoma is uncertain,
and an origin from cells of the neural crest has been proposed
[3]. To diagnose a case as primary melanoma, very strict criteria
apply.
melanoma of the urinary bladder [3]. These include (1) careful
physical examination including the skin with Wood’s light
together with detailed history to exclude cutaneous melanoma,
(2) exclusion of visceral melanoma following exhaustive
evaluation, (3) pattern of recurrence consistent with primary
melanoma of the urinary bladder, and (4) histologically proved
primary atypical melanocytes. This index patient of melanoma of
Memorial Cancer Hospital [5].
The symptoms caused by this tumour were varied,
(intravesical, intramural or extramural) [4,6,7]. In this patient,
the tumour was intravesical and at the outlet of bladder, causing
it was considered to be a benign enlargement of prostate. Some
authors have reported their patients having recurrent urinary
tract infections [8].
In this patient, the growth form of the tumour was involving
mucosal as well as deeper layers, that is the most common form
reported. However, some of the patients have an extravesical
growth form [4,7]. Ultrasonography, CT scan, and cystoscopy can
clearly delineate the exact position of the tumour most of the time,
although transvaginal or transrectal ultrasonography may show
better delineation [9]. In addition, magnetic resonance images
will clarify the position and size of the lesion [10]. In these men,
though USG and CT were done and both showed disease but we
needed transurethral visualization to suspect the disease. Some
authors have advocated the use of urine cytology in diagnosis as
well [10].
Reports show that surgical removal is the mainstay of
treatment of melanoma in any site of the body. Melanoma is bad
disease, have bad treatment options with grave prognosis. So
it is crucial to evaluate metastatic workup before commencing
aggressive treatment option. After proper evaluation; the
surgical approach is chosen according to the site and size of the
tumour. Transurethral resection of the lesion, partial cystectomy,
radical cystectomy, chemotherapy, and radiation therapy had
been used to treat melanoma of the urinary bladder [6,11,12].
It was stated by some authors that, in all patients with localised
tumour, radical surgery seemed to be the therapy of choice,
although to date none of the patients survived more than three
years despite cystectomy characterizing the poor prognosis of
the tumour [13,14]. TUR is a good option for treatment of small
tumours, but always not adhering to the surgical principle of
Figure 1
Figure 2 Immune-stain showing strong HMB 45 expression in tumour
Figure 3 Immuno-stain showing strong S100 expression in tumour
Prof. Jahn M Nesland, Norwegian Radium Hospital, Oslo, Norway)
We retrospectively examined the patient for any skin lesions.
Metastatic workup with CT scan of the whole body did not reveal
any other visceral lesions. After multi-disciplinary discussion,
the disease was considered to be primary urinary bladder
melanoma and underwent radical cystectomyprostatectomy and
urethrectomy with bilateral pelvic lymph node dissection and
ileo-caecal continent pouch urinary diversion. Post-operative
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Lamichhane N, Dhakal HP (2016) Melanoma of Urinary Bladder Presented as Acute Urine Retention. J Urol Res 3(3): 1054.
Cite this article
wide local excision [15,16]. In our patient, as the lesion was at
bladder outlet, invading into deeper layer, cysto-urethrectomy
with urinary diversion was performed. Though there are new
role [17,18]. Tarhini et al., suggested the use of neoadjuvant
chemotherapy and or immunotherapy in addition to surgery
to improve the outcome of management [19]. Kounalakis N in
the analysis of 153 stage III melanoma found even aggressive
systemic treatment prior to lymph node dissection does not
In conclusion, malignant melanomas are aggressive diseases.
Our patient died in 3 months due to extensive pulmonary
metastasis. We report this case for the sake of its rarity.
Individualization of treatment and multidisciplinary approaches
are highlighted.
ACKNOWLEDGEMENTS
We thank Dr Min Chu Lee for his help with arrangement of
frozen section biopsy of the tissue.
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