Open Journal of Obstetrics and Gynecology | 2021
Metastatic Ovarian Tumor of Vulvar Malignant Melanoma in a 43-Year-Old Woman: A Case Report and Literature Review
Abstract
An \novarian malignant melanoma sometimes occurs from ovarian teratoma. Ovarian \nmetastatic malignant melanoma is extremely rare. We describe a patient in whom \nvulvar melanoma (previously resected) metastasized to the ovary, making ovarian \nmetastatic malignant melanoma. A 43-year-old Japanese woman was referred to us \nbecause of left ovarian tumor. She had undergone resection for malignant \nmelanoma on the right labia minora with inguinal lymph node metastasis \n(pT1bN1aM0, stage IIIA, FIGO 2008). Eighteen months after this surgery, CT \nscans revealed left ovarian tumor and swelled pelvic lymph nodes, with a pelvic \nexamination disclosing a left adnexal solid mass, with normal serum CA125 level \n(21.7 U/mL). Laparotomy revealed a left solid ovarian tumor measuring 4 cm, \nwhich was covered with a smooth grayish capsule. The right ovary, uterus, and \npelvic cavity appeared normal. Upon sectioning during the surgery, the \ncross-sectional surface of the left ovary revealed a dark brown solid tumor. \nFollowing an intra-operative frozen-section diagnosis as metastatic melanoma, \ntotal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph \ndissection was performed. Histological examination confirmed the diagnosis as \nmalignant melanoma metastasis to the left ovary and the obturator lymph node: \nthe same laterality (left) as the primary site. The tumor was entirely composed \nof malignant melanoma cells with no evidence of teratoma. Combined chemotherapy \nwith dabrafenib mesylate and trametinib was planned based on the positive BRAF \nmutations. This case highlights the importance that physicians should have high \nindex of suspicion for the occurrence of ovarian melanoma metastasis after melanoma \nsurgery. We also made extensive literature review on this issue, of which \ndescription may contribute to better understanding of this condition.