TITLE:
Metastatic Ovarian Tumor of Vulvar Malignant Melanoma in a 43-Year-Old Woman: A Case Report and Literature Review
AUTHORS:
Yasuyuki Kawagoe, Midori Fujisaki, Tomoko Goto, Noriko Ueno, Junji Onishi, Kosuke Mochida, Yuichiro Sato, Hiroshi Sameshima
KEYWORDS:
Vulva, Malignant Melanoma, Ovarian Metastasis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.1,
January
14,
2021
ABSTRACT: An
ovarian malignant melanoma sometimes occurs from ovarian teratoma. Ovarian
metastatic malignant melanoma is extremely rare. We describe a patient in whom
vulvar melanoma (previously resected) metastasized to the ovary, making ovarian
metastatic malignant melanoma. A 43-year-old Japanese woman was referred to us
because of left ovarian tumor. She had undergone resection for malignant
melanoma on the right labia minora with inguinal lymph node metastasis
(pT1bN1aM0, stage IIIA, FIGO 2008). Eighteen months after this surgery, CT
scans revealed left ovarian tumor and swelled pelvic lymph nodes, with a pelvic
examination disclosing a left adnexal solid mass, with normal serum CA125 level
(21.7 U/mL). Laparotomy revealed a left solid ovarian tumor measuring 4 cm,
which was covered with a smooth grayish capsule. The right ovary, uterus, and
pelvic cavity appeared normal. Upon sectioning during the surgery, the
cross-sectional surface of the left ovary revealed a dark brown solid tumor.
Following an intra-operative frozen-section diagnosis as metastatic melanoma,
total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph
dissection was performed. Histological examination confirmed the diagnosis as
malignant melanoma metastasis to the left ovary and the obturator lymph node:
the same laterality (left) as the primary site. The tumor was entirely composed
of malignant melanoma cells with no evidence of teratoma. Combined chemotherapy
with dabrafenib mesylate and trametinib was planned based on the positive BRAF
mutations. This case highlights the importance that physicians should have high
index of suspicion for the occurrence of ovarian melanoma metastasis after melanoma
surgery. We also made extensive literature review on this issue, of which
description may contribute to better understanding of this condition.