A rare case of primary malignant melanoma of the scrotum diagnosed by fine‐needle aspiration

Abstract

We report a case of a 55-yr-old man with malignant melanoma of scrotum. He was referred to our Hospital with a complaint of gradual focal enlargement of the scrotum in a period of 3 yr. On physical examination, a pigmented, poorly marginated mass, with central necrosis was observed. A fine-needle aspiration (FNA) of the lesion was performed. Cytological examination revealed highly cellular smears, containing malignant cells, dispersed or arranged in loose aggregates. Cellular morphology and characteristics were identical to those of malignant melanoma arising elsewhere in the skin. The immunocytochemical study revealed positivity of neoplastic cells for anti-melanoma monoclonal antibody (HMB-45) antigen. Histological confirmation finally was provided after wide excision of the lesion. We emphasize the difficulties in differential diagnosis considerations and diagnostic pitfalls of scrotal lesions.

A Malignant Transformation in a Pre-Existing Benign Scrotal Naevus

“…The commonest presentation of melanoma of the scrotum which had been reported earlier was a pigmented macule or a papule [5]. At times, the lesion presents as a pigmented exophytic mass with ulceration, satellite lesions and palpable inguinal lymphadenopathy, as was seen in our patient [6][7].…”

“…Some authors suggest that primary scrotal melanoma may have a more favourable prognosis than the other genitourinary malignancies [5]. We feel that this may be true for those tumours which present as small pigmented macules or papules, but those which present as large, exophytic, ulcerative masses have a poor prognosis, as in our patient, who died from the disease within 1 month of the diagnosis [7][8].…”

FNA diagnosis of malignant melanoma-recurrent and metastatic disease

“…The prognosis of melanoma varies with the site and stage of the disease 27 28. Advanced disease with local recurrence, or distant metastasis carries a grave prognosis 29…”

Clinical Cytology in the Diagnosis and Management of Melanoma

“…As for the microscopic picture, irrespective of primary, recurrent, metastatic, melanotic or amelanotic melanomas; a striking cytomorphologic feature documented by most authors is its high cell-yield with a predominant population of dissociated cells (Woyke et al, 1980;Perry et al, 1986;Nasiell et al, 1991Deshpande et al, 2001Saqi et al, 2002;De Las Casas et al, 2004;Parwani et al, 2004;Damala et al, 2004;Siddaraju et al, 2007). Marked cellularity and nuclear pleomorphism; with plasmacytoid (cells with eccentrically placed nuclei), polygonal or spindle cells; inclusion-like prominent nucleoli; intra-nuclear cytoplasmic inclusions; increased mitotic activity; and variable number of bi-and multinucleated cells are the other features frequently observed in melanoma (Woyke et al, 1980;Perry et al, 1986;Kapila et al, 1991;Layfield et al, 1993;Dey et al, 1996;Deshpande et al, 2001;Saqi et al, 2002;Kashyap et al, 2002;Gupta et al, 2003;Artal et al, 2004;Gombos et al, 2004;Siddaraju et al, 2007).…”