Cutaneous Metastasis in a Previously Known Case of Ovarian Dysgerminoma: A Case Report

Abstract

Introduction: Cutaneous metastasis is an uncommon manifestation that mostly occurs in patients with previous gastrointestinal or gynecological malignancies. Local recurrence usually can be seen in surgical incisions. Dysgerminomas are rare ovarian tumors that usually have local invasions, but metastases are infrequent. Here, we described a case of dysgerminoma and cutaneous metastasis in the surgical incision. Case Presentation: The patient was a 39-year-old woman previously known as ovarian dysgerminoma, who had undergone surgery one year ago. Ultrasound examination a year after surgery showed a 35 × 33 millimeters hypoechoic solid tumor in the left ovary and another 3 masses with similar echo pattern and vascularity were found in the surgical incision. Magnetic resonance imaging (MRI) findings were compatible with cutaneous metastasis of pervious dysgerminoma. Pathologic evaluation and Immunohistochemistry (IHC) confirmed dysgerminoma's skin metastasis. She received chemotherapy due to the recurrence of malignancy. Conclusions: Local recurrence and metastases (even in the skin) should be kept in mind and the clinician must examine the surgical site skin in patients with a history of malignancy.

Diagnosis and Management of Dysgerminomas with a Brief Summary of Primitive Germ Cell Tumors

“…For a differential diagnosis with other ovarian tumors, cancer antigen 125 (CA-125) can be used [ 9 ]. The differential diagnosis is made with early or ectopic pregnancy, due to the presence of BHCG [ 4 , 27 ], uterine fibroids [ 10 ], other forms of acute abdomen [ 10 ], lymphoma or leukemia in case of atypical skin or breast metastases [ 28 ] and endometriosis [ 14 ].…”

“…Dysgerminomas can complicate by rupture, torsion, hemorrhage or incarceration [ 9 , 10 , 11 ]. Either they can give local metastases (neighboring tissue), via lymphatic, or distant hematogenous metastases in bones, lungs, the omentum, kidneys [ 3 , 8 ], the breast and skin (rarely but aggressively) [ 12 , 13 ] or the neck [ 14 ]. Confirmation diagnosis for germinoma metastasis is made by histopathological examination using immunohistochemistry [ 14 , 28 ].…”

“…In these situations, most of the time, the gonads are found in the inguinal canal [ 6 ]. However, in the case of typical dysgerminoma, we prefer a unilateral oophorectomy with the preservation of fertility [ 2 , 9 , 10 , 13 , 14 ]. Tumor cytoreduction is followed by the best survival [ 8 , 17 ].…”

“…Recurrence reaches 20% in 2 years and is successfully treated by adjunctive methods, chemotherapy with platinum-based therapy with good efficiency and tolerability and, rarely, radiotherapy [ 5 , 7 , 9 , 14 , 30 ]. This type of tumor can spread peritoneally, lymphatically and distantly, in bone, lungs, liver and brain ( Figure 3 ).…”

“…The favorite treatment is the surgical removal of the tumor and the preservation of fertility [ 2 , 7 , 10 , 13 , 14 ], but, in the case of hermaphroditism, mixed germ cells tumor can develop, which leads to a more aggressive evolution, with a risk of malignancy in the bilateral of the gonads, which is why removal of both ovotestis is required [ 15 ]. Recurrence reaches 20% in 2 years, after being successfully treated by adjuvant methods, chemotherapy with platinum-based therapy with good efficiency and tolerability and, rarely, radiotherapy [ 7 ].…”