Ovarian cystic teratoma with primary epithelial cell melanoma

We report a rare case of malignant melanoma arising in a cystic teratoma of the ovary occurring in a 60-year-old woman who died in four months despite the combined treatment administrated (surgery and chemotherapy). Diagnosis of ovarian melanoma was confirmed by immunohistochemical positivity to S-100 protein and HMB 45. There was no evidence of extra-ovarian primary melanoma on clinical examination; therefore the diagnosis was primary ovarian melanoma. Melanoma metastases were detected on the uterus, the right ovary, the omentum and in one of the three excised left external iliac lymph nodes. A review of the literature is analyzed and discussed.

Ovarian cystic teratoma; Ovarian dermoid cyst; Malignant melanoma; Malignant degeneration; Chemotherapy

[1] Andrews H.R.: "Primary melanotic sarcoma of the ovary". Trans. Obstet. Soc., 1901, 43, 228.

[2] Amann J.A.: "Primares melanosarkom des ovariums (abstr.)". Zntrlbl. Gynaekol., 1903, 27, 213.

[3] Lorrain M.: "Kyste dermoide de l'ovaire degenerescence sarcomateuse, rupture spontonee". Presse Med., 1905, 41, 421.

[4] Winterwitz M.C.: "Primary melanotic sarcoma of the ovary". Bull. Johns Hopkins. Hosp., 1909, 20, 314.

[5] Soubevran, Rives: "Le sarcome melanique pimitif de l'ovaire". Arch. Gen. Chir., 1911, 5, 1098.

[6] Van Hoosen B.: "Melanosarcoma of the ovary". Surg. Gynecol. Obstet., 1922, 35, 240.

[7] Schockaert R., Lambillon J., Naulaerts A.A.: "Apropos d'un cas de melano-sarcome de l'ovaire". Bull. Soc. Belg. Gynecol., 1938, 14, 74.

[8] Otken L.B.: "Primary melanotic sarcoma of the ovary". Am. J. Surg., 1942, 55, 160.

[9] Marcial Rojas R.A., De Arellano G.A.R.: "Malignant melanoma arising in a dermoid cyst of ovary". Cancer, 1956, 9, 523.

[10] Jernstroma P., MacMuffly H.: "Malignant melanoma of the ovary". Am. J. Clin. Pathol., 1959, 32, 557.

[11] Bruening E.G.H.: "Malignant melanoma originating in a dermoid cyst of the ovary". Am. J. Obstet. Gynecol., 1963, 9, 523.

[12] Park H., Kramer E.E., Gray G.F.: "Primary malignant melanoma in an ovarian dermoid cyst". Am. J. Obstet. Gynecol., 1970, 106, 942.

[13] Hameed K., Burslein M.R.: "A melanotic ovarian neoplasm resembling the'retinal anlage' tumor". Cancer, 1970, 25, 564.

[14] Leo S., Rorat E., Parekh M.: "Primary malignant melanoma in a dermoid cyst of the ovary". Obstet. Gynecol., 1973, 41, 259.

[15] Ladouch A., Fabre M., Veillefond A., Quillard J., Paillas J.: "Malignant melanoma occurring on a dermoid cyst of the ovary. Pancreatic metastasis". Arch. Anat. Pathol. Paris, 1975, 23, 217.

[16] Cronje H.S., Woodruff I.D.: "Primary ovarian malignant melanoma arising in a cystic teratoma". Gynecol. Oncol., 1981, 12, 379.

[17] Tham K.T., Ma P.H., Kung T.M.: "Malignant melanoma in an ovarian cystic teratoma". Hum. Pathol., 1981, 12, 577.

[18] Gregg R.H.: "Primary malignant melanoma arising in an ovarian dermoid cyst". Am. J. Obstet. Gynecol., 1982, 143, 25.

[19] Pareck M.A.: "Primary malignant melanoma in an ovarian cystic teratoma. A case report and literature review". Mo. Med., 1985, 82, 18.

[20] Siu J.G.H., Kemp G.M., Given F.T., D'Amato N.A.: "Malignant melanoma presenting as unilateral ovarian neoplasm". Gynecol. Oncol., 1986, 24, 362.

[21] Tsukamoto N.T., Matsukuma J., Kamura T.: "Primary malignant melanoma arising in a cystic teratoma of the ovary". Gynecol. Oncol., 1986, 123, 395.

[22] Boughton R.S., Hugmanick S., Marin Padilla H.: "Malignant melanoma arising in an ovarian cystic teratoma in pregnancy". J Am. Acad. Dermatol., 1987, 17, 871.

[23] Nambu Y., Fuji S., Konishi I., Nonogaki H., Mori T., Woodruff J.D.: "Primary ovarian malignant aI11e!anotic melanoma arising in cystic teratoma". Gynaecol. Oneal., 1990, 37, 138.

[24] Takubo K., Kimura T., Suzuki K., Ono K., Tsukahara K., Okura F. et al.: "Malignant melanoma arising in ovarian cystic teratoma". Gynecol. Oneal., 1991, 43, 77.

[25] Ueda Y., Kimura A., Kawahara E., Kitagawa H., Nakanishi I.: "Malignant melanoma arising in a dermoid cyst of the ovary". Cancer, 1991, 67, 3141.

[26] Selak I., Doric M., Kapidzich M.: "Malignant melanoma arising a cystic dermoid teratoma". Jugosl. Gynekol. Perinatal., 1991, 31, 37.

[27] Borup K., Leisg扛d R.K., Schierup L., Moller J.C.: "Amelanotic malignant melanoma arising in an ovarian dermoid cyst". Acta Obstet. Gynecol. Scand., 1992, 71, 242.

[28] Carlson J.A.J., Wheeler J.E.: "Primary ovarian melanoma arising in a dermoid stage Ille: Long-term disease-free survival with aggressive surgery and platinum therapy". Gynecol. Oneal., 1993, 48, 397.

[29] Di Vagno G., Mele M., Resta L., Maiorano E., Loverro G., Salzillo F. et al.: "Primary malignant melanoma arising in an ovarian dermoid cyst: Proposed use of radioimmunoscintigraphy with 99mTc-F(ab')2 antimelanoma antibody for staging and follow-up. Case report". Eur. J. Gynaecol. Oneal., 1993, 14.

[30] Davis G.L.: "Malignant melanoma arising in mature ovarian cystic teratoma (dermoid cyst). Report of two cases and literature analysis". Int. J. Gynecol. Pathol., 1996, 15, 356.

[31] Vigliani R., Iandolo M., Lacivita A.: "Mature ovarian cystic teratoma with combined squamous cell carcinoma and malignant melanoma". Wirchows Arch., 1998, 433, 381.

[32] Liberati F., Maccio T., Ascani S., Farabi R., Lancia D., Peciarolo A. et al.: "Primary malignant melanoma arising in an ovarian cystic teratoma". Acta Oneal., 1998, 37, 381.

[33] Vimla N., Kumar L., Thulkar S., Bal S., Dawar R.: "Primary malignant melanoma in ovarian cystic teratoma". Gyn. Oncol., 2001, 82, 380.

[34] Moehrle M., Fischbach H., Nuessle B., Rassner G.: "Primary malignant melanoma arising in a cystic necrotic ovarian teratoma". Eur. J. Obstet. Gynecol. Reprod. Biol., 2001, 99, 268.

[35] Das Gupta T., Brasfield R.: "A metastatic melanoma: A clinicopathological study". Cancer, 1964, 17, 1323.

[36] Peterson WF. Malignant degeneration of benign cystic teratomas of the ovary: a collective review of literature. Obstet. Gynecol. Surv., 1957, 12, 793.

[37] Hermann W.J.J., Humes J.J.: "A compound nevus in a bemgn cystic teratoma of the ovary". Am. J. Clin. Pathol., 1976, 66, 54.

[38] Otero E., Haberland J., Valdes R., Hernandez P., Cabrera D.: "Malignant melanoma in an ovarian dermoid cyst". Rev. Chil. Obstet. Ginecol., 1995, 60, 43.

[39] Gonzalez M.S., Hammond D.0.: "Malignant melanoma in the ovary with ultrastructural confrrmation". Am. J. Obstet. Gynecol., 1983, 147, 722.

[40] Dietl J.: "Current aspects of ovarian carcinoma". Geburthilfe Freuenheilkd, 1996,"56, 331.

[41] Legha S.S., Ring S., Eton 0., Bedikian A., Buzaid A.C., Plager C., Papadopoulos N.: "Development of biochemotherapy regimen with concurrent administration of cisplatin, vimblastine, dacarbazine, interferon alfa and interleukin-2 for patients with metastatic melanoma". J. Clin. Oneal., 1998, 16, 1752.