Transplacental transmission of metastatic melanoma to the posterior fossa

Abstract

The authors describe the first documented case of transplacental transmission of metastatic melanoma to the neuraxis. The patient was a 7-month-old boy who presented with signs and symptoms of elevated intracranial pressure. Magnetic resonance imaging revealed an inhomogeneously enhancing posterior fossa mass measuring 5 x 5 x 6 cm and filling the fourth ventricle. A posterior fossa craniotomy was performed. Pathological studies confirmed the presence of a metastatic melanoma that was pathologically identical to that of his mother. The boy received aggressive chemotherapy and underwent an additional resection. He also required a ventriculoperitoneal shunt for treatment of his hydrocephalus. He lived longer than any other patient with transplacental transmission of metastatic melanoma but ultimately died of the disease, 18 months after his initial presentation.

Spontaneous regression of transplacental metastases from maternal melanoma in a newborn: case report and review of the literature

“…This is the second reported case of foetal intracranial metastases from maternal melanoma. The first case was described by Trumble et al [23] who reported on metastases to the posterior fossa.…”

“…Skin lesions are the most frequent sites of foetal metastases with a mean age of presentation of 2 months and male predominance [8,[22][23][24]. It has been reported Foetal metastases in the mastoid.…”

Metastatic melanoma positively influences pregnancy outcome in a mouse model: could a deadly tumor support embryo life?

“…This tendency to metastasize to these structures is intriguing and poorly understood [12][13][14]. In combination with the fetal immune system, the placental barrier is remarkably efficient at preventing the spread and allografting of the maternal tumor into the fetus and the transmission of neoplastic and non-neoplastic maternal cells to the fetus that occurs during pregnancy involves only aggressive and rapidly growing tumors such as melanomas and hematological malignancies [22].…”

“…Most of the publications on the management and treatment of metastatic melanoma in pregnancy have focused on the mother, with scarce analysis of placental and fetal involvement [4,8,12]. Furthermore, the mechanism by which melanoma is able to overcome the transplacental barrier is not well understood, and there are no well-established prognostic factors that predict the increased probability of such fetal as placental metastasis [11,13,14].…”

“…Melanoma accounts for more than 50% of all tumors in pregnancy that metastasize to placenta and fetus [2,[11][12][13][14]. Thus in these patients, both placenta and fetus should be examined thoroughly [2,15].…”