Introduction. Malignant melanoma accounts for 3% of all cancers in Europe. Malignant melanoma of the genitourinary tract is very rare, accounting for 1% of all cases. In addition, primary malignant melanoma of the urethra accounts for 0.2% of all melanomas and 4% of all urethral cancers. The abnormal migration of melanocytes during the embryonic development may explain their occurrence in the urethra. Also, vulva contains a relatively high concentration of melanocytes, so it may be the reason for higher incidence of malignant melanomas in females than in males, especially located at the meatus or in the distal urethra. Case Report. A 60-year-old woman presented with a solid tumor protruding through the vaginal introitus. Computerized tomography revealed a 5 cm large tumor of the urethra, infiltrating the bladder neck and the anterior vaginal wall. In addition, a bilateral pelvic lymphadenopathy was observed. The patient underwent anterior pelvic exenteration with urethrectomy, bilateral pelvic lymphadenectomy and bilateral ureterocutaneostomy, followed by immunochemotherapy. Nonetheless, the patient died 10 months after the surgery. Conclusion. Urethral melanoma is a tumor with a very poor prognosis and high recurrence rate (71%), even after wide surgical resection, adjuvant radiotherapy, chemo and immunotherapy.
Introduction. Rupture of the urinary collecting system, associated with perirenal or retroperitoneal extravasation of the urine, is a rare condition usually associated with the obstruction of the urinary system. A urinoma is a localized collection of urine in the retroperitoneum, outside the urinary tract, and occurs after injury to the wall of the urinary system. Ureteral obstruction caused by a bladder tumor is a rare cause of urinoma. Case Report. We report a case of a 62-year-old patient who was admitted to the Clinic of Urology of the Clinical Center of Serbia, due to an invasive bladder cancer. A computerized tomography scan of the abdomen and pelvis revealed a massive bladder tumor dominant on the left side, invading the vagina, uterus and significantly obstructing both kidneys. Intraoperatively, a mass of 18 cm in diameter was identified in the right retroperitoneal space and it was dissected from the peritoneum. Two liters of clear fluid were aspirated from the mass, and the walls of urinoma were resected. The site of perforation was not identified. The patient underwent anterior pelvic exenteration. The pathohistological analysis revealed a high grade transitional cell carcinoma of the bladder. The treatment is individual and involves surgical and interventional radiology treatment. Conclusion. A spontaneous retroperitoneal urinoma is a very rare condition. In this case report it appeared most likely due to right ureteral obstruction and perforation. The growth of urinoma was slow, due to the absence of acute symptoms and the thickness of the urinoma wall.
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