Radiation Oncology Journal

  • 제21권3호
  • /
  • Pages.245-249
  • /
  • 2003
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지

질의 원발성 악성 흑색종: 증례보고

Primary Malignant Melanoma of the Vagina: A Case Report

  • 장지영 (가톨릭대학교 의과대학 대전성모병원 방사선종양학과) ;
  • 김도강 (가톨릭대학교 의과대학 대전성모병원 산부인과) ;
  • 이은희 (가톨릭대학교 의과대학 대전성모병원 병리과) ;
  • 김준상 (충남대학교 의과대학병원 치료방사선과학교실)
  • Jang Ji-Young (Department of Radiation Oncology College of Medicine, Catholic University) ;
  • Kim Do-Kang (Department of Gynecology, Daejeon St. Mary's Hospital, College of Medicine, Catholic University) ;
  • Lee Eun-Hee (Department of Pathology, Daejeon St. Mary's Hospital, College of Medicine, Catholic University) ;
  • Kim Jun-Sang (Department of Therapeutic Radiology, College of Medicine, Chungnam National University)
  • 발행 : 2003.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

여성의 질에 발생하는 원발성 악성 흑색종은 매우 드문 질환으로 알려져 있다. 질의 원발성 흑색종은 피부나 외음부에 발생하는 원발성 흑색종에 비해 매우 빠른 임상경과를 나타낸다. 본 증례는 58세의 폐경기 여자환자로 종양 크기가 비교적 큰 흑색종이 하부 질에 있었으며, 작은 색소침착된 병변이 자궁경부에 보였다. 환자는 수술적인 처치 없이 통상 분할 외부방사선 조사와 근접방사선 치료 만을 시행하였다 치료 후 원발병소는 부분관해를 보였으나, 진단 후 4.5개월만에 다발성 원격전이로 사망하였다. 종양크기가 큰 흑색종이 질에 발생한 경우 방사선치료 단독으로도 만족할만한 국소제어를 보였지만, 본 증례와 같이 종양의 크기가 큰 예에서는 소분할방사선 조사와 수술적인 종양제거로 국소치료기간을 단축하고, 전신적인 치료를 고려하여 조기에 발생하는 원격전이를 막기 위한 치료가 고려되어야 할 것으로 사료된다.

A primary malignant melanoma of the vagina is a very rare gynecological malignant tumor. Its clinical behavior is more aggressive than that of cutaneous and vulvar melanomas. We present a case of a large sized primary melanoma of the lower third of the vagina, with a cervical lesion, in a 58-year-old postmenopausal woman. The patient was treated with conventional external radiation therapy and intracavitary radiotherapy (ICR), without surgical treatment. Although the primary lesion showed a partial response, the patient died of extensive metastases, which were found 4.5 months after the initial diagnosis. We suggest that shortening the treatment period, such as hypofractionated radiation therapy and surgical removal, and various systemic therapies for preventing early distant metastasis, are appropriate treatments for a primary malignant melanoma of the vagina, with a large tumor size.

키워드

참고문헌

  1. Piura B, Rabinovich A, Yanai-Inbar I. Primarymalignant melanoma of the vagina: case report and review of literature. Eur J Gynecol Oncol 2002;23(3):195-198
  2. Ragnarsson-Olding B, Jonansson H, Rutqvist L, Ringborg U. Malignant melanoma of the vulva and vagina. Cancer 1993;71:1893-1897 https://doi.org/10.1002/1097-0142(19930301)71:5<1893::AID-CNCR2820710528>3.0.CO;2-7
  3. Creasman WT, Phillips JL, Menck HR. The national cancer data base report on cancer of the vagina. Cancer 1998;83(5):1033-1040 https://doi.org/10.1002/(SICI)1097-0142(19980901)83:5<1033::AID-CNCR30>3.0.CO;2-6
  4. IrvinWP,BlissSA,RiceLW,TalyorPT,AndersenWA. Malignant melanoma of the vagina and locoregional control: radical surgery revisited. Gynecol Oncol 1998;71:476-480 https://doi.org/10.1006/gyno.1998.5188
  5. Petru E, Nagels F, Czerwenka K, et al. Primary malignantmelanomaofthevagina: long term remission following radiation therapy. Gynecol Oncol 1998;70:23-26 https://doi.org/10.1006/gyno.1998.4982
  6. Cobellis L, Calabrese E, Stefanon B, Raspagliesi F. Malignant melanoma of the vagina. A report of 15 cases. Eur J Gynecol Oncol 2000;21(3):295-297
  7. Fan SF, Gu WZ, Zhang JM. MR findings of malignant melanoma of the vagina: case report. Br J Radiol 2001;74: 445-447 https://doi.org/10.1259/bjr.74.881.740445
  8. Levitan Z., Gordon AN, Kaplan AL, Kaufman RH. Primary malignant melanoma of the vagina: report of fourcasesand review of theliterature. Gynecol Oncol 1989;33:85-90
  9. Morrow CP,DiSaia PJ. Malignant melanoma of the female genitalia. a clinical analysis. Obstet Gynecol Surv 1976;31:233-271 https://doi.org/10.1097/00006254-197604000-00001
  10. NevenP,ShepherdJH,Masotina A,FisherC,LoweDG. Malignant melanoma of the vulva and vagina: a report of 23 cases presenting in a 10-year period. Int J Gynecol Cancer 1994;4:379-383 https://doi.org/10.1046/j.1525-1438.1994.04060379.x
  11. Buchanan DJ, Schlaerth J, Kurosaki T. Primary vaginal melanoma: thirteen-year disease free survival after wide local excision and review of recentliterature.Am J Obstet Gynecol 1998;178:1177-1184 https://doi.org/10.1016/S0002-9378(98)70320-5
  12. Rodier JF, Jancer JC, David E, Routiot T, Ott G. Radiopharmaceutical-guided surgery in primary malignant melanoma of the vagina. Gynecol Oncol 1999;75:308-309 https://doi.org/10.1006/gyno.1999.5577
  13. Reid G, Schmidt R, Roberts J, Hopkins M, Barett R, Morley G. Primary melanoma ofthevagina:Aclinicopathologic analysis. Obstet Gynecol 1989;74:190-199
  14. Geisler JP, Look KY, Moore DA, Sutton GP. Pelvic exenteration for malignant melanomas of thevagina or urethra with over 3 mm of invasion. Gynecol Oncol 1995; 59:338-341 https://doi.org/10.1006/gyno.1995.9966
  15. Van Nostrand KM, Lucci III JA, Schell M, Berman ML, Manetta A, Disaia PJ. Primary vaginal melanoma: Improved survival with radical pelvic surgery. Gynecol Oncol 1994;55:234-237 https://doi.org/10.1006/gyno.1994.1283
  16. Bonner JA, Perez-Tamayo C, Reid GC, Roberts JA, Morley GW. The management of vaginal melanoma. Cancer 1988;62:2066-2072 https://doi.org/10.1002/1097-0142(19881101)62:9<2066::AID-CNCR2820620933>3.0.CO;2-D
  17. KirkwoodJM, StrawdermanMH,ErnstoffMS,SmithTJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resectedcutaneous melanoma: the Eastern Cooperative Oncology Group TrialEST. J Clin Oncol 1996;14: 7-17 https://doi.org/10.1200/JCO.1996.14.1.7
  18. Satellato G, Iodice F, Casella G, et al. Primary malignant melanoma of the vagina: case report. Eur J Gyneco Oncol 1998;19(2):186-188