Laparoscopic pancreaticoduodenectomy and laparoscopic pancreaticoduodenectomy with robotic reconstruction: single-surgeon experience and technical notes

Purpose@#Despite the increasing number of robotic pancreaticoduodenectomies, laparoscopic pancreaticoduodenectomy (LPD) and LPD with robotic reconstruction (LPD-RR) are still valuable surgical options for minimally invasive pancreaticoduodenectomy (MIPD). This study introduces the surgical techniques, tips, and outcomes of our experience with LPD and LPD-RR. @*Methods@#Between March 2014 and July 2021, 122 and 48 patients underwent LPD and LPDRR respectively, at CHA Bundang Medical Center in Korea. The operative settings, procedures, and trocar placements were identical in both approaches; however, different trocars were used. We introduced our techniques of retraction methods for Kocherization and uncinate process dissection, pancreatic reconstruction, pancreatic division, and protection using the round ligament. The perioperative surgical outcomes of LPD and LPD-RR were compared. @*Results@#Baseline demographics of patients in the LPD and LPD-RR groups were comparable, but the LPD group had older age (65.5 ± 11.6 years vs. 60.0 ± 14.1 years, p = 0.009) and lesser preoperative chemotherapy (15.6% vs. 35.4%, p = 0.008). The proportion of malignant disease was similar (LPD group, 86.1% vs. LPD-RR group, 83.3%; p = 0.759). Perioperative outcomes were also comparable, including operative time, estimated blood loss, clinically relevant postoperative pancreatic fistula (LPD group, 9.0% vs. LPD-RR group, 10.4%; p = 0.684), and major postoperative complication rates (LPD group, 14.8% vs. LPD-RR group, 6.2%; p = 0.082). @*Conclusion@#Both LPD and LPR-RR can be safely performed by experienced surgeons with acceptable surgical outcomes. Further investigations are required to evaluate the objective benefits of robotic surgical systems in MIPD and establish widely acceptable standardized MIPD techniques.

ARID1A Mutation from Targeted Next-Generation Sequencing Predicts Primary Resistance to Gemcitabine and Cisplatin Chemotherapy in Advanced Biliary Tract Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#There are clinical unmet needs in predicting therapeutic response and precise strategy for the patient with advanced biliary tract cancer (BTC). We aimed to identify genomic alterations predicting therapeutic response and resistance to gemcitabine and cisplatin (Gem/Cis)-based chemotherapy in advanced BTC. @*Materials and Methods@#Genomic analysis of advanced BTC multi-institutional cohorts was performed using targeted panel sequencing. Genomic alterations were analyzed integrating patients’ clinicopathologic data, including clinical outcomes of Gem/Cis-based therapy. Significance of genetic alterations was validated using clinical next-generation sequencing (NGS) cohorts from public repositories and drug sensitivity data from cancer cell lines. @*Results@#193 BTC patients from three cancer centers were analyzed. Most frequent genomic alterations were TP53 (55.5%), KRAS (22.8%), ARID1A (10.4%) alterations, and ERBB2 amplification (9.8%). Among 177 patients with BTC receiving Gem/Cis-based chemotherapy, ARID1A alteration was the only independent predictive molecular marker of primary resistance showing disease progression for 1st-line chemotherapy in the multivariate regression model (odds ratio, 3.12; p=0.046). In addition, ARID1A alteration was significantly correlated with inferior progression-free survival on Gem/Cis-based chemotherapy in the overall patient population (p=0.033) and in patients with extrahepatic cholangiocarcinoma (CCA) (p=0.041). External validation using public repository NGS revealed that ARID1A mutation was a significant predictor for poor survival in BTC patients. Investigation of multi-OMICs drug sensitivity data from cancer cell lines revealed that cisplatin-resistance was exclusively observed in ARID1A mutant bile duct cancer cells. @*Conclusion@#Integrative analysis with genomic alterations and clinical outcomes of the first-line Gem/Cis-based chemotherapy in advanced BTC revealed that patients with ARID1Aalterations showed a significant worse clinical outcome, especially in extrahepatic CCA. Well-designed prospective studies are mandatory to validate the predictive role of ARID1Amutation.

Yonsei Criteria, a Potential Linkage to Intratumoral Foxp3⁺/CD8⁺ Ratio for the Prediction of Oncologic Outcomes in Resected Left-Sided Pancreatic Cancer

PURPOSE: This study sought to investigate associations among Yonsei criteria (tumor confined to the pancreas, intact fascia layer between the distal pancreas and the left adrenal gland and kidney, and tumor located more than 1–2 cm from the celiac axis) and tumor infiltrating lymphocytes in pancreatic cancer.MATERIALS AND METHODS: Patients who underwent curative distal pancreatectomy due to left-sided pancreatic cancer from January 2000 to December 2011 were enrolled. Follow-up was completed September 30, 2015.RESULTS: Fifty patients were enrolled. Having ≥ two metastatic lymph nodes (LNs, p=0.002), intraoperative transfusion (p=0.011), low levels of tumor infiltrating CD8⁺ T-cells (p=0.001), and a high Foxp3⁺/CD8⁺ ratio (p=0.009) were independent risk factors for disease-free survival. Not satisfying the Yonsei criteria (p=0.021), having ≥ two metastatic LNs (p=0.032), low levels of tumor infiltrating CD8⁺ T-cells (p=0.040) and a high Foxp3⁺/CD8⁺ ratio (p=0.032) were associated with unfavorable overall survival. High levels of CA19-9 and not satisfying the Yonsei criteria were significantly associated with a high Foxp3⁺/CD8⁺ ratio [Exp(β)=3.558; 95% confidence inverval: 1.000–12.658; p=0.050].CONCLUSION: Yonsei criteria may be clinically detectable biologic marker with which to predict immunologic status and survival in pancreatic cancer patients.

Relationship between the values of blood parameters and physical status in Korean native calves with diarrhea

ehydration, electrolyte disturbance, and acid-base imbalance are the most significant consequences of diarrhea in calves. We aimed to determine blood gas, hematological, electrolyte, and biochemical values and investigate the relationship between the physical status and blood parameters in Korean native calves (KNCs) with diarrhea. One hundred eighty KNCs with diarrhea (age < 75 days) were investigated. Blood samples were collected from the external jugular vein and analyzed using a portable clinical blood gas analyzer. The measured parameters were statistically compared according to the status of physical activity, dehydration, or prognosis. The mean values of parameters in the Calves with diarrhea showed metabolic acidosis, hyponatremia, and azotemia. The mean values of potassium, chloride, hematocrit, and hemoglobin were in the upper limit of their reference ranges. More than 75% of the calves had metabolic acidosis caused by bicarbonate loss, and 63.6% had high blood urea nitrogen (BUN) values. Moreover, BUN showed the highest correlation with the physical activity status and dehydration. pH, base excess of the extracellular fluid (BE), anion gap, potassium, hematocrit, bicarbonate, and hemoglobin were closely correlated with physical deterioration and dehydration (p < 0.001). BUN, pH, BE, and anion gap were closely correlated with physical deterioration and dehydration. These correlations between clinical symptoms and blood gas parameters can be clinically relevant in predicting the status of parameters according to clinical symptoms.

Preoperative Metabolic Tumor Volume(2.5) Associated with Early Systemic Metastasis in Resected Pancreatic Cancer: A Transcriptome-Wide Analysis

BACKGROUND/AIMS: ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG-PET) reflects biological aggressiveness and predicts prognoses in various tumors. Evaluating the oncologic significance of the preoperative metabolic phenotype might be necessary for planning the surgical strategy in resectable pancreatic cancers. METHODS: From January 2010 to December 2015, a total of 93 patients with pathologic T3 (pT3) pancreatic cancer were included in this study. Clinicopathological parameters and PET parameters were evaluated, and transcriptome-wide analysis was performed to identify the oncologic impact and molecular landscape of the metabolic phenotype of resectable pancreatic cancers. RESULTS: Preoperative metabolic tumor volume (MTV)(2.5) was significantly higher in the pN1 group compared to the pN0 group (11.1±11.2 vs 6.5±7.8, p=0.031). Higher MTV(2.5) values (MTV(2.5) ≥4.5) were associated with multiple lymph node metastasis (p=0.003), and the lymph node ratio was also significantly higher in resected pT3 pancreatic cancer with MTV(2.5) ≥4.5 compared to those with MTV(2.5) <4.5 (0.12±0.13 vs 0.05±0.08, p=0.001). Disease-specific survival of patients with MTV(2.5) <4.5 was better than that of patients with MTV(2.5) ≥4.5 (mean, 28.8 months; 95% confidence interval [CI], 40.1 to 57.0 vs mean, 32.6 months; 95% CI, 25.5 to 39.7; p=0.026). Patients with MTV(2.5) ≥4.5 who received postoperative adjuvant chemotherapy showed better survival outcomes than patients with MTV(2.5) ≥4.5 who did not receive adjuvant treatment in resected pT3 pancreatic cancers (p<0.001). Transcriptome-wide analysis revealed that tumors with MTV(2.5) ≥4.5 demonstrated significantly different expression of cancer-related genes reflecting aggressive tumor biology. CONCLUSIONS: Resectable pancreatic cancer with high MTV(2.5) is not only associated with lymph node metastasis but also early systemic metastasis. The molecular background of resectable pancreatic cancer with high MTV(2.5) may be associated with aggressive biologic behavior, which might need to be considered when managing resectable pancreatic cancers. Further study is mandatory.

Causative agents and epidemiology of diarrhea in Korean native calves

Calf diarrhea caused by infectious agents is associated with economic losses in the cattle industry. The purpose of this study was to identify the causative agents and epidemiological characteristics of diarrhea in Korean native calves (KNC). In total, 207 diarrheal KNC aged less than 7 months were investigated. Fecal samples collected from the rectum were examined for causative agents using polymerase chain reaction (PCR) or real-time PCR and the number of oocysts were counted. Fourteen causative agents were detected from 164 of the 207 diarrheal KNC. Rotavirus was the most common agent (34.8%), followed by Eimeria spp. (31.7%), Escherichia coli (22.0%), Giardia spp. (14.0%), Clostridium difficile (9.8%), bovine viral diarrhea virus (8.5%), coronavirus (7.9%), Cryptosporidium spp. (7.3%), torovirus (6.7%), parvovirus (5.5%), norovirus (4.9%), kobuvirus (1.8%), adenovirus (1.2%), and Salmonella spp. (0.6%). About 95 (57.9%) of 164 calves were infected with a single causative agent and 42.1% were infected by multiple agents. No significant difference was observed in mortality between calves infected with a single agent and multiple agents. The occurrence of diarrhea caused by rotavirus, Eimeria spp., kobuvirus, and Giardia spp. was significantly different based on onset age, and the prevalence of diarrhea caused by rotavirus or C. difficile was significantly different between seasons. This study help the understanding of KNC diarrhea for the development of an effective strategy for disease prevention and control, especially in Eastern provinces of South Korea.

Aggressive surgical resection for concomitant liver and lung metastasis in colorectal cancer

BACKGROUNDS/AIMS: Aggressive surgical resection for hepatic metastasis is validated, however, concomitant liver and lung metastasis in colorectal cancer patients is equivocal. METHODS: Clinicopathologic data from January 2008 through December 2012 were retrospectively reviewed in 234 patients with colorectal cancer with concomitant liver and lung metastasis. Clinicopathologic factors and survival data were analyzed. RESULTS: Of the 234 patients, 129 (55.1%) had synchronous concomitant liver and lung metastasis from colorectal cancer and 36 (15.4%) had metachronous metastasis. Surgical resection was performed in 33 patients (25.6%) with synchronous and 6 (16.7%) with metachronous metastasis. Surgical resection showed better overall survival in both groups (synchronous, p=0.001; metachronous, p=0.028). In the synchronous metastatic group, complete resection of both liver and lung metastatic lesions had better survival outcomes than incomplete resection of two metastatic lesions (p=0.037). The primary site of colorectal cancer and complete resection were significant prognostic factors (p=0.06 and p=0.003, respectively). CONCLUSIONS: Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable cases. Colorectal cancer with concomitant liver and lung metastasis is not a poor prognostic factor or a contraindication for surgical treatments, hence, an aggressive surgical approach may be recommended in well-selected resectable cases.

The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

PURPOSE: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. MATERIALS AND METHODS: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). RESULTS: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. CONCLUSION: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.

Fatal liver injury complicated by percutaneous catheter drainage after distal pancreatosplenectomy in a patient with pancreatic cancer

Postoperative pancreatic fistula (POPF) combined with postoperative fluid collection, bleeding and abscess formation is one of the most critical morbidities after distal pancreatectomy or pancreaticoduodenectomy. Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection. Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage. Herein, we report a case of unexpected fatal liver injury complicated by percutaneous catheter drainage treatment after distal pancreatosplenectomy in a patient with pancreatic cancer. We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

Comparison of pathogens and antimicrobial susceptibility of Staphylococcus aureus isolated from conventional and robotic milking herds / 대한수의학회지

This study was conducted to compare the patterns of mastitic pathogens and the antimicrobial susceptibility of Staphylococcus (S.) aureus from conventional milking (CM) and robotic milking (RM) dairy herds. To accomplish this, the minimum inhibitory concentrations of 14 antimicrobial agents were tested against S. aureus by the microdilution method. Regardless of the milking system, S. aureus, coagulase negative staphylococcus, and Streptococcus uberis were isolated. Additionally, significant differences in the antimicrobial susceptibility of S. aureus isolates between RM and CM farms were only observed in response to tetracycline.

AFP-producing acinar cell carcinoma treated by pancreaticoduodenectomy in a patient with a previous radical subtotal gastrectomy by gastric cancer

We report a case of alpha-fetoprotein (AFP)-producing acinar cell carcinoma (ACC) of the pancreas. The tumor was diagnosed in a 72 yearold female after radical subtotal gastrectomy (Billroth I) due to early gastric cancer six months before. The initial serum AFP levels were increased to 2,254.1 IU/ml and preoperative imaging studies showed a mass with approximately 2.5 cm in diameter near the neck of the pancreas. A pancreaticoduodenectomy was performed. The pathologic examination revealed an ill-defined lobulating tumor confined to the pancreas (T1 stage). Immunohistochemical study showed that the tumor cells expressed AFP. The Adenosine triphosphate-based chemotherapy response assay (ATP-CRA) suggested that cisplatin would be more desirable than gemcitabine in AFP-producing ACC of the pancreas as an adjuvant chemotherapy. However, the adjuvant chemotherapy was not performed due to the early pathological stage. The patient died from carcinomatosis and pneumonia. Even if the tumor was on a relatively early stage, an adjuvant treatment should be considered ACC.

Urachal cyst presenting with huge abscess formation in adults / 대한외과학회지

Urachal disease, a disorder where embryonic remnant of the cloaca and the allantois present after birth as a midline fibrous cord, is usually detected in infancy and childhood. But urachal disease in adults is rare. We report a case of a huge abscess derived from a urachal cyst in an adult. A 52-year-old man presented with peri-umbilical distension and abdominal pain for 2 weeks. Ultrasonography and abdominal computed tomography scan demonstrated a huge abscess derived from the abdominal wall. After prompt incision and drainage, the remaining abscess cavity was removed completely under general anesthesia. Pathologic report was consistent with urachal duct cyst, and the patient was discharged in a week without complication.

Retiform Hemangioendothelioma on the Finger

No abstract available.

Shoulder Augmentation

As the breast of woman is considered as a symbol of femininity, the shoulder of man is regarded as a symbol of masculinity. Narrow shoulders disallow proper fitting of male clothing and result disproportionately large and unbalanced facial look in men. The purpose of this article was to evaluate the aesthetic outcomes of shoulder augmentation using soft silicone in patients with narrow shoulders. From April 2009 to July 2010, 21 male patients received shoulder augmentation by using silicone implants in the subfascial space of the deltoid muscle. The silicone implant was prefabricated according to the shape of the lateral portion of the deltoid muscle, and placed in subfascial pocket. After the operation, the shoulder width was increased by 6.6cm on average and patients were satisfied with their augmented shoulders, giving them more sharp figure when wearing their clothes. The firmness of the soft silicone is similar that of the deltoid muscle, and the curvature of the implant looks like a natural deltoid muscle. The subfascial position of the implant does not limit the range of motion of the shoulder joint. The authors expect that shoulder augmentation will take part in a new entity of body contouring surgery.

Subservient Bone Reduction with Histoacryl(R) (N-butyl-2-cyanoacrylate) in Hand Fractures: Two Cases of Report

PURPOSE: The standard treatments of hand fractures today are fixations by K -wires, metal plates, wires and lag screws. But it is very difficult to reconstruct fractures by placing implants into small bony fragments especially in the comminuted fractures and intra-articular fractures. This paper describes a simple method of reconstruction with Histoacryl(R) for comminuted and intra-articular fractures in hands. METHODS: 2 cases with comminuted and intra-articular fractures by crushing injury were reconstructed with Histoacryl(R). We performed applying Histoacryl(R) with swab on the bone cortex carefully to avoid Histoacryl(R) infiltrating into the medulla. We could rearrange and fixate bony fragments using only Histoacryl(R), in addition, metal plates, K-wires, wires, and lag screws could be used for secondary fixation if needed. RESULTS: Post-operative X-ray finding of 2 patients assured that the bony fragments of the hand fractures maintained their original positions. Significant displacement and deviation, infection, nonunion, and malunion during the follow-up period were not observed. CONCLUSION: This study showed the possibility of using Histoacryl(R) in addition as a simple method of fixation in the comminuted and intra-articular hand fractures.

CO2 Laser Resurfacing in Skin Tumor Surgery

PURPOSE: The prevalence of skin cancers and cutaneous premalignant lesions are increasing recently. It is necessary to treat cutaneous premalignant lesions, because these can progress to invasive skin cancers. We conducted a retrospective study to evaluate the usefulness of CO2 laser resurfacing in skin tumor surgery. METHODS: From 2005 to 2008, 14 patients with skin cancers, photodamaged skin and cutaneous premalignant lesions were treated with skin cancer excision, immediate reconstruction, and CO2 facial laser resurfacing. Mean average follow-up period was 15.6 months(5 months-36 months). Biopsy and clinical photograph were taken preoperatively, intraoperatively and through follow-up period to assess the effectiveness of laser resurfacing. Recurrence and side effects were evaluated through follow-up period. RESULTS: Histologic examination shows the abolition of actinic atypia, regeneration of epidermis and normalization of cellular differentiation after laser resurfacing. Clinical photographs shows elimination of keratoses and spots, and the homogeneous, smoothening change of skin surface, indicating healthy and younger faces. All patients had remained free of skin cancers and premalignant lesions in laser-treated field through follow-up period. CONCLUSION: CO2 laser resurfacing in skin tumor surgery can treat not only premalignant lesions but also subclinical lesions of photodamaged skin. Moreover it may be helpful in prophylaxis against skin cancers and premalignant lesions, providing rejuvenation and cosmetic improvement.

Traumatic Displacement of the Globe into the Ethmoid Sinus: Case Report

We experienced a rare case of traumatic displacement of the globe into the ethmoid sinus. A 66-year-old man sustained trauma of the right eye and orbit, which resulted in displacement of the globe into the ethmoid sinus. One day after injury, surgery was performed to restore the intact globe into position within the orbit. Ten days after the operation, light perception was noticed only when transillumination was placed into orbit. Trace test undergone 45 days after the operation, no sight were measured from right eye, and the movement of right eyeball was not possible in any direction. We believe that the nerve and extraocular muscles were severed against the floor of the orbit or severely traumatized as the globe entered the ethmoid sinus. This case is very rare and never reported in Korea. We treated by replacing the globe in the orbit surgically and reconstructing the orbital floor with acurate diagnosis by the Computed Tomography(CT) scan.

A Clinical Analysis of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To report our experience with laparoscopically assisted vaginal hysterectomy (LAVH) and evaluate the advantages of LAVH. This is a retrospective study. METHODS: From Jan. 2001 to Aug. 2002, 204 LAVHs were performed at the Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, The Catholic University of Korea. We studied the results with regard to the age, parity, previous abdominal surgery, surgical indications, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complications. RESULTS: The mean age was 43.9+/-6.4 years. The mean parity was 2.1+/-1.3. Tubal ligation was most common previous abdominal surgery. As a surgical indication, leiomyoma (52.9%) and adenomyosis (33.3%) were more common indications than any other gynecological problem. The mean operation time was 85.7+/-22.4 minutes. The mean uterine weight was 206.2+/-103.7 g. The mean hemoglobin change was 1.2+/-0.7 g/dl. The mean hospital stay was 3.3+/-0.8 days. Unilateral salpingoophorectomy was most common operation as concomitant procedure. Surgical complication rate was 3.4%. CONCLUSION: LAVH is a safe and effective alternative to abdominal hysterectomy with advanced technologic development in laparoscopic instruments and skills.

A case of Primary Malignant Fibrous Histiocytoma of the Round Ligament / 대한산부인과학회잡지

In adults, although malignant fibrous histiocytoma (MFH) is the most frequent malignant soft tissue tumor. Primary malignant fibrous histiocytoma of the round ligament of the uterus is comparatively very rare. A patient presented with severe lower abdominal pain and a palpable pelvic mass in the lower abdomen. Emergency laparotomy revealed a 15 X 15 cm tumor located in the left round ligament and adhered with uterus and intestine. The patient underwent total abdominal hysterectomy and bilateral salpingectomy. The final diagnosis was based on the pathological report of the surgical specimen.

A Case of Primary Malignant Melanoma of the Vagina / 대한산부인과학회잡지

Primary melanoma of the vagina is rare, accounting for 2.6-2.8% of all primary malignant tumor of the vagina and 0.4-0.8% of all malignant melanomas in the female. Melanocytes are the presumed precursors of malignant melanoma of the vagina; they are embryologically derived from neural crest cells and can be found in the basal portion of the vaginal epidermis in 3% of normal adult females. Though malignant melanoma may occur anywhere in the vagina, it is most commonly found on the anterior wall and in the distal one-third. Vaginal bleeding is the most common symptom. Histochemical and immunohistochemical procedures confirm the initial diagnosis. Vaginal melanoma is a highly malignant disease; due to the extensive lymphatic invasion and melanoma's propensity for hematogeneous spread, so early metastases are very common. The treatment modalities for the primary management of vaginal melanoma are varied according to the location and extend, individually or in combination, wide local incision, radical surgical extirpation, irradiation, or chemotherapy. Although there have been no consensus as to comprehensive treatment, in the case of upper vaginal melanoma, radical abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymph node dissection is generally advocated. Regardless of primary therapy chosen, result of the treatment of vaginal melanoma has been uniformly poor. We experienced a case of malignant melanoma of the vagina confirmed pathohistologically after radical abdominal hysterectomy with bilateral salpingo-oophorectomy and presented with a brief review of literature.