Primary Malignant Melanoma in Ovarian Cystic Teratoma

Vimla, N.; Kumar, Lalit; Thulkar, Sanjay; Bal, Sabyasachi; Dawar, Ramesh

doi:10.1006/gyno.2001.6223

Cited by 38 publications

(29 citation statements)

References 13 publications

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“…15,25 The median age of these patients has been reported to be 48.5 years, and the patients present with symptoms secondary to an enlarged ovary. 25 After follow-ups ranging from 2 months to 2 years, 47% of the patients were disease free, while the other 53% died of progressive disease with distant spread to lymph nodes, lung, liver, and bone. 25 Our patient is alive with no evidence of disease after a follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 98%

“…19 In contrast, about 32 cases of primary ovarian melanoma arising in a mature cystic teratoma have been reported. 15,25 Previously, two series have addressed the clinicopathologic features of metastatic melanoma in the ovary. 7,28 The varied appearance that metastatic melanomas assume poses diagnostic difficulties in the ovary, especially in the absence of a previous diagnosis or history.…”

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confidence: 99%

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Malignant Melanoma Involving the Ovary: A Clinicopathologic and Immunohistochemical Study of 23 Cases

Gupta

Deavers

Silva

et al. 2004

American Journal of Surgical Pathology

102

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Ovarian malignant melanoma (MM), primary or metastatic, is an extremely rare tumor and in the absence of a previous diagnosis can represent a diagnostic challenge. We present the clinicopathologic and immunohistochemical features of 23 cases seen in our institution over a period of 40 years (1962-2001). The patients' age ranged from 14 to 53 years (mean 35.7 years). Ethnicity was known in 19 patients: 14 white, 4 Hispanic, and 1 black. A previous history of MM was definitively obtained in 14 patients; in these cases, the interval between the primary MM and the ovarian metastasis ranged from 15 to 228 months (mean 77.7 months). The tumor was unilateral in 19 and bilateral in 4 cases. The tumor size ranged from 4.5 to 23 cm (average 10 cm); the melanoma arising in a cystic teratoma was 0.2 mm in thickness. The tumor was grossly pigmented in 8 cases (35%). The architectural pattern was nodular (8 cases), diffuse (6 cases), nodular and diffuse (5 cases), nested (3 cases), and lentiginous arising in a teratoma (1 case). Follicle-like spaces were seen in 8 cases, pseudo-glandular areas in 1 case, pseudo-myxoid areas in 1 case, and cords in 1 case. The tumor cell type was epithelioid in 19 cases, spindled in 2 cases, mixed epithelioid and spindled in 1 case, and small cell in 1 case. Nucleoli were prominent in 18 cases, and nuclear inclusions were present but rare in the majority of cases. Nuclear grooves were seen in 3 cases. Necrosis was extensive in 8 cases, focal in 10 cases, and was absent in 5 cases. In 8 cases, initial diagnoses included sex cord stromal tumor, germ cell tumor, sarcoma, or undifferentiated carcinoma. S-100 was positive in 18 of 19 cases, HMB-45 in 17 of 20 cases, MART-1 in 13 of 15 cases, tyrosinase in 10 of 15 cases, and Mitf in 8 of 14 cases. Inhibin was positive in 3 of 14 cases. Calretinin was focally positive in 1 of 12 cases. Treatment performed in 18 of the cases are as follows: oophorectomy with/without chemotherapy (10); total abdominal hysterectomy with bilateral salpingo-oophorectomy with/without chemotherapy (6); vaginal hysterectomy, bilateral salpingo-oophorectomy, and chemotherapy (1); and total abdominal hysterectomy with salpingo-oophorectomy (1). Follow-up ranging from 2 to 96 months was available in 18 patients. All but one had metastases in other organs, most often in the lungs. Thirteen patients died of disease (range 2-76 months), 3 are alive with disease (6-18 months), and 2 have no evidence of disease at 24 and 96 months; one was the patient with melanoma arising within a teratoma. In conclusion, MM involving the ovary is a rare disease, predominantly seen in women of reproductive age, and is associated with a poor prognosis. The tumor is most often metastatic from another site and is unilateral in most cases. Nodular or diffuse pattern and epithelioid cell type are most frequently seen, and the tumor can be mistaken for germ cell and sex cord stromal tumors. S-100 is the most sensitive marker. MART-1 was positive in the few cases that were negative with HMB-45. Inhibin ca...

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Malignant Melanoma Involving the Ovary: A Clinicopathologic and Immunohistochemical Study of 23 Cases

Gupta

Deavers

Silva

et al. 2004

American Journal of Surgical Pathology

102

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“…Foci of hemorrhage and necrosis within the malignant component are common. The most common secondary tumor is squamous cell carcinoma, corresponding to up to 80% of such neoplasms, but several malignancies have already been reported, including adenocarcinomas, adenosquamous carcinomas, undifferentiated carcinomas, sarcomas, carcinosarcomas, and melanomas [1,14,16,17,24,30]. Other neoplasms arising in teratomas include carcinoid tumors, thyroidtype tumors, and neuroectodermal tumors [3,12,22,25].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological and immunohistochemical features of a sebaceous carcinoma arising within a benign dermoid cyst of the ovary

Ribeiro‐Silva

Chang

Bisson³

et al. 2003

Virchows Archiv

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Pure sebaceous neoplasms arising in dermoid cysts of the ovary are exceedingly rare. A 63-year-old female with abdominal swelling and pain underwent a right salpingo-oophorectomy that showed a unilocular cyst weighing 830 g and measuring 15x12x10 cm, filled with sebaceous material containing a few hair shafts. The cyst wall exhibited plaques protruding into the cavity of the cyst. Microscopy revealed a dermoid cyst with nests and lobules of atypical and infiltrating sebaceous cells surrounded by basaloid cells. The tumor cells stained diffusely for high-molecular-weight cytokeratins and focally for cytokeratin 7, cytokeratin 19, epithelial membrane antigen and carcinoembryonic antigen in the immunohistochemistry study. Low-molecular-weight cytokeratins, cytokeratin 20, vimentin, S100, p63, estrogen receptor, progesterone receptor, p53 and c-erbB-2 were negative in tumoral cells. The proliferative labeling index (Ki67 and proliferating cell nuclear antigen) was low. Basal cell carcinoma with sebaceous differentiation and sebaceoma must be considered in the differential diagnosis. However, the presence of obvious malignant sebaceous differentiation in nearly every tumor nest and lack of peripheral palisading and peri-tumoral myxoid stroma excluded these diagnoses. Some histogenetic concepts relevant to this case are discussed along with a brief review of this neoplasm. To our knowledge, this is the sixth case report of a sebaceous carcinoma arising in a mature cystic teratoma of the ovary.

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“…6 To date, only 46 cases have been reported in the literature, of which one report is a compilation of 20 cases. [1][2][3][4][8][9][10][11][12] Differentiation of primary from metastatic melanoma in the ovary is challenging for pathologists. 13 This differentiation is mostly based on the criteria proposed by Cronje and Woodruff, 14 which is provided in Box 1.…”

Section: Discussionmentioning

confidence: 99%

“…The most-common histology is squamous-cell carcinoma (88%), followed by adenocarcinoma (7%), and melanoma (which is very rare). [1][2][3][4][5][6] Case A 58-year-old woman presented with a history of dull aching pain and progressive abdominal distension of 2 months' duration. There was no history of any suspicious pigmented skin lesions or surgery for any such skin lesions in her past.…”

Section: Introductionmentioning

confidence: 99%

Metastasizing Primary Malignant Melanoma of the Ovary: A Diagnostic Enigma

Hulikal

BanothManilal

GangasaniRevanth

et al. 2015

Journal of Gynecologic Surgery

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Background: Primary melanoma of the ovary is very rare; fewer than 50 cases have been reported to date. The diagnosis is challenging and is usually one of exclusion of the more-common metastatic diseases. This article describes such a case in detail and reviews relevant literature. Case: A 58-year-old perimenopausal woman presented with a 2-month history of pain and distension of the abdomen. On evaluation, she was found to have bilateral ovarian complex cysts with ascites. In view of her elevated CA 125 level and positive ascitic fluid cytology, she underwent a staging laparotomy. The final histopathology was reported as a malignant melanoma of the left ovary within a cystic teratoma with metastatic involvement of the right ovary, peritoneum, omentum, and mesentery. Results: Following surgery, this patient was evaluated with a whole body F18 flourodeoxyglucose positron emission tomography/computed tomography scan to look for any probable site of primary or other metastatic areas that had not revealed any other sites of disease. She was referred to the medical oncology services of the Sri Venkateswara Institute of Medical Sciences, in Tirupathi, Chittoor District, AP, India, for further treatment. As of this writing, she had completed two cycles of temozolomide chemotherapy with few side-effects. Conclusions: Primary malignant melanoma of the ovary is difficult to diagnose without a component of teratoma. Even with teratomatous elements, this is a diagnosis that involves excluding more-common metastatic disease from a more-common cutaneous primary. ( J GYNECOL SURG 31:166)

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Primary Malignant Melanoma in Ovarian Cystic Teratoma

Cited by 38 publications

References 13 publications

Malignant Melanoma Involving the Ovary: A Clinicopathologic and Immunohistochemical Study of 23 Cases

Malignant Melanoma Involving the Ovary: A Clinicopathologic and Immunohistochemical Study of 23 Cases

Clinicopathological and immunohistochemical features of a sebaceous carcinoma arising within a benign dermoid cyst of the ovary

Metastasizing Primary Malignant Melanoma of the Ovary: A Diagnostic Enigma

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