- Email: [email protected]
Ovarian metastasis of malignant melanoma: The first pediatric case
J Ped Surg Case Reports 2 (2014) 473e475
Contents lists available at ScienceDirect
Journal of Pediatric Surgery CASE REPORTS journal homepage: www.jpscasereports.com
Ovarian metastasis of malignant melanoma: The first pediatric caseq Yuko Araki a, *, Hide Kaneda a, Kohei Oashi b, Sathoshi Okada c, Arata Tsutsumida b a
Department of Pediatric Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan c Department of Gynecology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 24 July 2014 Received in revised form 16 September 2014 Accepted 17 September 2014
We report a case of an 8-year-old girl with metastasis of malignant melanoma (MM) to the ovary. She was initially diagnosed with cutaneous MM on the left buttock for which she underwent wide local excision, left inguinal/pelvic lymph node dissection, and subcutaneous injection of interferon beta. In spite of the treatment, she developed dissemination of MM to the liver, the bone, and the right ovary. All the lesions responded well to systemic chemotherapy (intravenous dacarbazine), except for the right ovarian tumor. She underwent an elective right salpingo-oophorectomy to avoid torsion or rupture of the tumor. However, she developed metastases to the contralateral ovary with peritoneal dissemination in 4 months. She received home palliative care and died at home 14 months after the last surgery. Ovarian metastasis of MM is a rare form of dissemination, and only 15 adult cases have ever been reported. Our patient is the first pediatric case. Since there is no standard of surgical indication for metastatic MM to the ovary, palliative resection can be an option for improving quality of life of a patient with this rare condition. Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved.
Key words: Malignant melanoma Ovarian tumor Metastasis
Metastasis of malignant melanoma to the ovary is a rare form of dissemination, and no pediatric case has ever been reported. We present a case of an eight-year-old girl, the first case report of this condition in pediatric population.
1. Case report The patient is an 8-year-old girl who was diagnosed with malignant melanoma (MM) on the left buttock. At the age of 3, she underwent excision of congenital melanocytic nevi on the left buttock. When she was 6 years old, a black-colored skin lesion was noticed in the same area which rapidly increased in size over 6 months. Incisional biopsy of the lesion confirmed pathological diagnosis of MM. She underwent wide local excision of the lesion plus sentinel lymph node (LN) biopsy which was positive (pT4bN2bM0, stage IIIB; Clark’s level V, ulceration (þ)). She was referred to our institution for LN dissection of the left inguinal area
q This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/3.0/). * Corresponding author. Tel.: þ81 3 3542 2511; fax: þ81 3 3545 3567. E-mail address: [email protected] (Y. Araki).
and the pelvis. Postoperatively, she received subcutaneous injection of interferon beta (3 million units per day, total 24 doses). However, she developed dissemination of MM to the liver, bone (the spine (Th12) and the ilium), and the right ovary. Her spine was with compression fracture. She received radiation therapy to the spine lesion (45 Gy/18 fractions) and systemic chemotherapy (intravenous dacarbazine, 1000 mg/m2/day, given every 2 weeks 4). Although the liver and bone lesions responded well to treatments, her right ovary enlarged from 2 cm to 6 cm within a month (Fig. 1). Serum tumor markers were normal except elevated LDH. To avoid an acute abdomen from ovarian torsion or rupture, she underwent an elective right salpingo-oophorectomy. Total 1200 ml of bloody ascites was evacuated at laparotomy, and right salpingo-oophorectomy was completed. Post-operative course was uncomplicated and she was discharged from the hospital on post-operative day 8. Pathologic examination confirmed diagnosis of metastatic melanoma of the ovary; macroscopic examination revealed an elastic-soft nodule (2.5 1.5 0.8 cm) inside of the thinned ovarian capsule. Immunohistochemical stains were positive for HMB-45 and antiMelan-A (Fig. 2). In spite of additional 13 doses (total 17 doses) of intravenous dacarbazine, her CT scan taken at 4 months from surgery showed enlarged left ovary accompanied by multiple peritoneal
2213-5766/$ e see front matter Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.epsc.2014.09.010
474
Y. Araki et al. / J Ped Surg Case Reports 2 (2014) 473e475
Fig. 1. Preoperative CT of the right ovary, measured 6 5 cm.
disseminations and ascites. She received home palliative care and died at home 14 months after the last surgery. 2. Discussion MM of children is rare, but has been increasing. It consists 1e3% of pediatric malignancies, and only 0.4% of all malignant melanoma cases [1]. According to Surveillance, Epidemiology, and End Results (SEER) program data from 1973 through 2009, the age-adjusted incident rate of MM in children and adolescents less than 20 years of age was 6.0 per million and increased by an average of 2% per year [2]. Ovarian metastasis of MM is a rare form of disseminated MM, and only 15 adult cases have been reported (Table 1) [3e17]. The youngest patient in the previous reports was a 20-year-old [3]. Therefore, this is the youngest report of MM in the ovary. Symptoms of the ovarian metastasis vary from asymptomatic to acute abdomen (abdominal pain, abdominal distention, shock) [3e17]. Eleven out of the 15 cases were seen with sudden onset of abdominal pain [3e7,9,11,14e17], and 3 of them had rupture of the ovarian tumor prior to laparotomy [3,5,16]. Prognosis of MM with distant metastases is poor. According to Barth et al., the median survival time of the 1521 patients they
studied was 7.5 months, and the estimated five-year survival rate was 6 percent [18]. Metastasis of MM to the ovary has unpredictable clinical and biological behavior and poor prognosis due to the aggressiveness of the tumor [16]. Ten out of the 15 cases were reported to be dead [3,6,8,10,12e17], and seven died within a year after surgery to the ovary [6,8,10,12,13,15,16]. Because of the rarity of this form of metastasis, there is no standard surgical indication for ovarian MM. When reviewing the 15 cases in Table 1, there could be a chance of improved survival with oophorectomy in late recurrent cases; among eight cases which developed ovarian metastases five years or beyond from the initial diagnosis of MM, five cases (62.5%) survived one year or beyond after oophorectomy [7,9,10,14,17]. The National Comprehensive Cancer Network (NCCN) guideline offers palliative resection and/or radiation as an option for symptomatic patients with disseminated MM [19]. Although our patient was asymptomatic, we performed an elective right oophorectomy for several reasons. First, as the ovary was rapidly enlarging, we wanted to avoid having to perform an emergency laparotomy to remove a ruptured ovary. Secondly, the right oophorectomy would yield several benefits: 1) after removal of the large tumor, systemic chemotherapy would likely be more effective; 2) removal of the large tumor would also better facilitate supportive care as the risks of an emergency operation would be reduced. Another reason for selection of a right oophorectomy over a bilateral was the patient’s young age. Although gynecologists more commonly perform bilateral oophorectomy on similar adult patients, we felt that in this situation a more conservative approach was warranted. The parents expressed a strong desire to preserve one ovary. Although four months later, the patient developed left (contralateral) ovarian metastasis plus peritoneal dissemination, we felt our original approach was still warranted. 3. Conclusion We reported on an 8-year-old girl with ovarian metastasis of MM. Since no standard therapy is established on this form of metastasis and the ovarian tumor can enlarge to induce lifethreatening acute abdomen, palliative resection (salpingo-oophorectomy) can be an option for improving the QOL of the affected patient. Indication of surgery should be decided weighing the risks
Fig. 2. Histopathology of the right ovarian tumor showing metastasis of malignant melanoma. (A) Hematoxylin and eosin stain (100). (B) Anti-HMB45 stain (400). (C) Anti-Melan-A stain (400).
Y. Araki et al. / J Ped Surg Case Reports 2 (2014) 473e475
475
Table 1 Published cases of metastasis of malignant melanoma to the ovary. No.
Age (years)
Laterality of the affected ovary
Clinical symptoms
Surgery
Site of primary lesion
Time from initial diagnosis to ovarian metastasis
Outcome (time from surgery)
Author (year)
1 2
20 40
Rt Lt
Abd pain Abd pain
SO (Rt) SO (Bil), H
9 Mo (1) 7 Mo (2) 1 Mo
Died (NA) Alive (NA)
Silveira E (1977) Agnello (1981)
3
42
Rt
Abd pain, shock
2 Yr
NA
Nanu VK (1985)
4
42
Bil
Abd pain, malaise
Skin (right heel)
16 Mo
Died (2 Mo)
Stjernholm J (1991)
5
46
Bil
Skin (vulva)
10 Yr
Alive (1 Yr)
Meier HM (1995)
6
35
Bil
Abd pain, urinary incontinence Abd mass
SO (Rt); 2 L of blood evacuated SO (Bil), H, OM and appendectomy SO (Bil), H, OM, and appendectomy SO (Bil)
Skin (left breast) (1) Skin (left paraumbilical zone); (2) skin (left breast) Skin (right calf)
8 yr
Died (5 Mo)
Bilgin T (2000)
7
47
Rt
Abd pain
SO (Rt)
Skin (temporal scalp) Right eye (uvea)
14 Yr
Alive (14 Mo)
8
58
Rt
Abd mass
Skin (left antecubital fossa)
10 Yr
Died (1 Yr)
9 10
48 43
Bil Lt
Abd pain NA
NA Died (8 Mo)
Al-Shehabi Z (2006) Boutis A (2008)
39
Lt
8 Mo
Died (7 Mo)
Abe Y (2009)
12
35
Bil
Skin (upper back)
5 Yr
Died (15 Mo)
Fenzl V (2011)
13
45
Lt
Abd fullness, appetite loss Abd pain, fever, chills, fatigue, appetite loss and nausea Abd mass
Skin (left thigh) Skin (left antecubital region) Skin (left thigh)
2 Yr 9 Yr
11
SO (Bil), H, OM, and right pelvic lymphadenectomy SO (Bil), H US-guided aspiration of ascites SO (Lt), OM and peritoneal Bx SO (Bil), OM
Santeusanio G (2000) Oliver R (2005)
SO (Lt)
3 Yr
Died (11 Mo)
Sbitti (2011)
14
35
Rt
Abd pain, shock
SO (Rt)
7 Yr
Died (3 Mo)
Habek D (2012)
15
48
Lt
Abd pain
5 Yr
Died (4 Yr)
Berisavac M (2013)
16
8
Bil (metachronous)
Asymptomatic
SO (Bil), H, OM and pelvic lymphadenectomy SO (Rt)
Skin (sole of the right foot) Skin (interscapular region) Skin (right arm)
Skin (left buttock)
8 Mo
Died (14 Mo)
Araki Y (2014)
NA, not available; SO, salpingo-oophorectomy; H, hysterectomy; OM, omentectomy.
and benefits of surgery, with limited life expectancy of the patient in mind.
[10]
References [11] [1] Huynh PM, Grant-Kels JM, Grin CM. Childhood melanoma: update and treatment. Int J Dermatol 2005;44:715e23. [2] Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ. Incidence of childhood and adolescent melanoma in the United States: 1973e2009. Pediatrics 2013; 131:846e54. [3] Silveira E, Palhares FA, De Oliveira Filho JA, Alberti Jr O, Alberti VN, Silveira MI. Peritonitis following rupture of metastatic malignant melanoma of the ovary. Gynecol Oncol 1977;5:305e7. [4] Agnello G, Perri G, Cocilovo G. Malignant metastatic ovarian melanoma: a case report. Eur J Gynaecol Oncol 1981;2:119e20. [5] Nanu VK. Malignant metastatic ovarian melanoma e an unusual case-report. Br Med J 1985;290:606. [6] Stjernholm J, Borup K. Malignant melanoma with ovarian metastases. Ugeskr Laeger 1991;153:3330e1. [7] Meier HM, Geisler T. Ovarian metastasis of malignant melanoma e case report. Zentralbl Gynakol 1995;117:323e6. [8] Bilgin T. Late ovarian metastases of a cutaneous malignant melanoma. J Obstet Gynaecol 2000;20:323. [9] Santeusanio G, Ventura L, Mauriello A, Carosi M, Spagnoli LG, Maturo P, et al. Isolated ovarian metastasis from a spindle cell malignant melanoma of the choroid 14 years after enucleation e prognostic implication of the
[12]
[13]
[14] [15]
[16] [17] [18] [19]
keratin immunophenotype. Appl Immunohistochem Mol Morphol 2000;8: 329e33. Oliver R, Dasgupta C, Coker A, Al-Okati D, Weekes AR. Ovarian malignant melanoma: unusual presentation of a solitary metastasis. Gynecol Oncol 2005; 99:412e4. Al-Shehabi Z, Al-Soufi L. Metastatic ovarian tumor (Krukenberg’s tumor) from primary malignant melanoma of the skin: a case report. Mod Pathol 2006;19:40. Boutis A, Valeri R, Korantzis I, Valoukas D, Andronikidis I, Andreadis C. Delayed malignant melanoma recurrence simulating primary ovarian cancer: case report. World J Surg Oncol 2008;6:124. Abe Y, Takeuchi M, Matsuzaki K, Uehara H, Furumoto H, Nishitani H. A case of metastatic malignant melanoma of the ovary with a multilocular cystic appearance on MR imaging. Jpn J Radiol 2009;27:458e61. Fenzl V, Prkacin I, Skrtic A. Malignant melanoma ovarian metastasis mimicking acute tuboovarian abscess. Eur J Gynaecol Oncol 2011;32:582e4. Sbitti Y, Fadoukhair Z, Kadiri H, Oukabli M, Essaidi I, Kharmoum S, et al. Diagnostic challenge for ovarian malignant melanoma in premenopausal women: primary or metastatic? World J Surg Oncol 2011;9:65. Habek D, Marton I, Bauman R, Prka M, Bobic MV. Ruptured ovarian metastatic malignant melanoma caused acute abdomen. Cent Eur J Med 2012;7:241e4. Berisavac M, Kotlica BK, Pilic I, Atanackovic J. Metastatic malignant ovarian melanoma e a case report. Vojnosanit Pregl 2013;70:229e32. Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg 1995;181:193e201. National Comprehensive Cancer Network. NCCN clinical practice guideline in oncology, melanoma (Version 4, 2014). URL: http://www.nccn.org/ professionals/physician_gls/pdf/melanoma.pdf; 2014 [Accessed 23.07.14].
Contents lists available at ScienceDirect
Journal of Pediatric Surgery CASE REPORTS journal homepage: www.jpscasereports.com
Ovarian metastasis of malignant melanoma: The first pediatric caseq Yuko Araki a, *, Hide Kaneda a, Kohei Oashi b, Sathoshi Okada c, Arata Tsutsumida b a
Department of Pediatric Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan c Department of Gynecology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 24 July 2014 Received in revised form 16 September 2014 Accepted 17 September 2014
We report a case of an 8-year-old girl with metastasis of malignant melanoma (MM) to the ovary. She was initially diagnosed with cutaneous MM on the left buttock for which she underwent wide local excision, left inguinal/pelvic lymph node dissection, and subcutaneous injection of interferon beta. In spite of the treatment, she developed dissemination of MM to the liver, the bone, and the right ovary. All the lesions responded well to systemic chemotherapy (intravenous dacarbazine), except for the right ovarian tumor. She underwent an elective right salpingo-oophorectomy to avoid torsion or rupture of the tumor. However, she developed metastases to the contralateral ovary with peritoneal dissemination in 4 months. She received home palliative care and died at home 14 months after the last surgery. Ovarian metastasis of MM is a rare form of dissemination, and only 15 adult cases have ever been reported. Our patient is the first pediatric case. Since there is no standard of surgical indication for metastatic MM to the ovary, palliative resection can be an option for improving quality of life of a patient with this rare condition. Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved.
Key words: Malignant melanoma Ovarian tumor Metastasis
Metastasis of malignant melanoma to the ovary is a rare form of dissemination, and no pediatric case has ever been reported. We present a case of an eight-year-old girl, the first case report of this condition in pediatric population.
1. Case report The patient is an 8-year-old girl who was diagnosed with malignant melanoma (MM) on the left buttock. At the age of 3, she underwent excision of congenital melanocytic nevi on the left buttock. When she was 6 years old, a black-colored skin lesion was noticed in the same area which rapidly increased in size over 6 months. Incisional biopsy of the lesion confirmed pathological diagnosis of MM. She underwent wide local excision of the lesion plus sentinel lymph node (LN) biopsy which was positive (pT4bN2bM0, stage IIIB; Clark’s level V, ulceration (þ)). She was referred to our institution for LN dissection of the left inguinal area
q This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/3.0/). * Corresponding author. Tel.: þ81 3 3542 2511; fax: þ81 3 3545 3567. E-mail address: [email protected] (Y. Araki).
and the pelvis. Postoperatively, she received subcutaneous injection of interferon beta (3 million units per day, total 24 doses). However, she developed dissemination of MM to the liver, bone (the spine (Th12) and the ilium), and the right ovary. Her spine was with compression fracture. She received radiation therapy to the spine lesion (45 Gy/18 fractions) and systemic chemotherapy (intravenous dacarbazine, 1000 mg/m2/day, given every 2 weeks 4). Although the liver and bone lesions responded well to treatments, her right ovary enlarged from 2 cm to 6 cm within a month (Fig. 1). Serum tumor markers were normal except elevated LDH. To avoid an acute abdomen from ovarian torsion or rupture, she underwent an elective right salpingo-oophorectomy. Total 1200 ml of bloody ascites was evacuated at laparotomy, and right salpingo-oophorectomy was completed. Post-operative course was uncomplicated and she was discharged from the hospital on post-operative day 8. Pathologic examination confirmed diagnosis of metastatic melanoma of the ovary; macroscopic examination revealed an elastic-soft nodule (2.5 1.5 0.8 cm) inside of the thinned ovarian capsule. Immunohistochemical stains were positive for HMB-45 and antiMelan-A (Fig. 2). In spite of additional 13 doses (total 17 doses) of intravenous dacarbazine, her CT scan taken at 4 months from surgery showed enlarged left ovary accompanied by multiple peritoneal
2213-5766/$ e see front matter Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.epsc.2014.09.010
474
Y. Araki et al. / J Ped Surg Case Reports 2 (2014) 473e475
Fig. 1. Preoperative CT of the right ovary, measured 6 5 cm.
disseminations and ascites. She received home palliative care and died at home 14 months after the last surgery. 2. Discussion MM of children is rare, but has been increasing. It consists 1e3% of pediatric malignancies, and only 0.4% of all malignant melanoma cases [1]. According to Surveillance, Epidemiology, and End Results (SEER) program data from 1973 through 2009, the age-adjusted incident rate of MM in children and adolescents less than 20 years of age was 6.0 per million and increased by an average of 2% per year [2]. Ovarian metastasis of MM is a rare form of disseminated MM, and only 15 adult cases have been reported (Table 1) [3e17]. The youngest patient in the previous reports was a 20-year-old [3]. Therefore, this is the youngest report of MM in the ovary. Symptoms of the ovarian metastasis vary from asymptomatic to acute abdomen (abdominal pain, abdominal distention, shock) [3e17]. Eleven out of the 15 cases were seen with sudden onset of abdominal pain [3e7,9,11,14e17], and 3 of them had rupture of the ovarian tumor prior to laparotomy [3,5,16]. Prognosis of MM with distant metastases is poor. According to Barth et al., the median survival time of the 1521 patients they
studied was 7.5 months, and the estimated five-year survival rate was 6 percent [18]. Metastasis of MM to the ovary has unpredictable clinical and biological behavior and poor prognosis due to the aggressiveness of the tumor [16]. Ten out of the 15 cases were reported to be dead [3,6,8,10,12e17], and seven died within a year after surgery to the ovary [6,8,10,12,13,15,16]. Because of the rarity of this form of metastasis, there is no standard surgical indication for ovarian MM. When reviewing the 15 cases in Table 1, there could be a chance of improved survival with oophorectomy in late recurrent cases; among eight cases which developed ovarian metastases five years or beyond from the initial diagnosis of MM, five cases (62.5%) survived one year or beyond after oophorectomy [7,9,10,14,17]. The National Comprehensive Cancer Network (NCCN) guideline offers palliative resection and/or radiation as an option for symptomatic patients with disseminated MM [19]. Although our patient was asymptomatic, we performed an elective right oophorectomy for several reasons. First, as the ovary was rapidly enlarging, we wanted to avoid having to perform an emergency laparotomy to remove a ruptured ovary. Secondly, the right oophorectomy would yield several benefits: 1) after removal of the large tumor, systemic chemotherapy would likely be more effective; 2) removal of the large tumor would also better facilitate supportive care as the risks of an emergency operation would be reduced. Another reason for selection of a right oophorectomy over a bilateral was the patient’s young age. Although gynecologists more commonly perform bilateral oophorectomy on similar adult patients, we felt that in this situation a more conservative approach was warranted. The parents expressed a strong desire to preserve one ovary. Although four months later, the patient developed left (contralateral) ovarian metastasis plus peritoneal dissemination, we felt our original approach was still warranted. 3. Conclusion We reported on an 8-year-old girl with ovarian metastasis of MM. Since no standard therapy is established on this form of metastasis and the ovarian tumor can enlarge to induce lifethreatening acute abdomen, palliative resection (salpingo-oophorectomy) can be an option for improving the QOL of the affected patient. Indication of surgery should be decided weighing the risks
Fig. 2. Histopathology of the right ovarian tumor showing metastasis of malignant melanoma. (A) Hematoxylin and eosin stain (100). (B) Anti-HMB45 stain (400). (C) Anti-Melan-A stain (400).
Y. Araki et al. / J Ped Surg Case Reports 2 (2014) 473e475
475
Table 1 Published cases of metastasis of malignant melanoma to the ovary. No.
Age (years)
Laterality of the affected ovary
Clinical symptoms
Surgery
Site of primary lesion
Time from initial diagnosis to ovarian metastasis
Outcome (time from surgery)
Author (year)
1 2
20 40
Rt Lt
Abd pain Abd pain
SO (Rt) SO (Bil), H
9 Mo (1) 7 Mo (2) 1 Mo
Died (NA) Alive (NA)
Silveira E (1977) Agnello (1981)
3
42
Rt
Abd pain, shock
2 Yr
NA
Nanu VK (1985)
4
42
Bil
Abd pain, malaise
Skin (right heel)
16 Mo
Died (2 Mo)
Stjernholm J (1991)
5
46
Bil
Skin (vulva)
10 Yr
Alive (1 Yr)
Meier HM (1995)
6
35
Bil
Abd pain, urinary incontinence Abd mass
SO (Rt); 2 L of blood evacuated SO (Bil), H, OM and appendectomy SO (Bil), H, OM, and appendectomy SO (Bil)
Skin (left breast) (1) Skin (left paraumbilical zone); (2) skin (left breast) Skin (right calf)
8 yr
Died (5 Mo)
Bilgin T (2000)
7
47
Rt
Abd pain
SO (Rt)
Skin (temporal scalp) Right eye (uvea)
14 Yr
Alive (14 Mo)
8
58
Rt
Abd mass
Skin (left antecubital fossa)
10 Yr
Died (1 Yr)
9 10
48 43
Bil Lt
Abd pain NA
NA Died (8 Mo)
Al-Shehabi Z (2006) Boutis A (2008)
39
Lt
8 Mo
Died (7 Mo)
Abe Y (2009)
12
35
Bil
Skin (upper back)
5 Yr
Died (15 Mo)
Fenzl V (2011)
13
45
Lt
Abd fullness, appetite loss Abd pain, fever, chills, fatigue, appetite loss and nausea Abd mass
Skin (left thigh) Skin (left antecubital region) Skin (left thigh)
2 Yr 9 Yr
11
SO (Bil), H, OM, and right pelvic lymphadenectomy SO (Bil), H US-guided aspiration of ascites SO (Lt), OM and peritoneal Bx SO (Bil), OM
Santeusanio G (2000) Oliver R (2005)
SO (Lt)
3 Yr
Died (11 Mo)
Sbitti (2011)
14
35
Rt
Abd pain, shock
SO (Rt)
7 Yr
Died (3 Mo)
Habek D (2012)
15
48
Lt
Abd pain
5 Yr
Died (4 Yr)
Berisavac M (2013)
16
8
Bil (metachronous)
Asymptomatic
SO (Bil), H, OM and pelvic lymphadenectomy SO (Rt)
Skin (sole of the right foot) Skin (interscapular region) Skin (right arm)
Skin (left buttock)
8 Mo
Died (14 Mo)
Araki Y (2014)
NA, not available; SO, salpingo-oophorectomy; H, hysterectomy; OM, omentectomy.
and benefits of surgery, with limited life expectancy of the patient in mind.
[10]
References [11] [1] Huynh PM, Grant-Kels JM, Grin CM. Childhood melanoma: update and treatment. Int J Dermatol 2005;44:715e23. [2] Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ. Incidence of childhood and adolescent melanoma in the United States: 1973e2009. Pediatrics 2013; 131:846e54. [3] Silveira E, Palhares FA, De Oliveira Filho JA, Alberti Jr O, Alberti VN, Silveira MI. Peritonitis following rupture of metastatic malignant melanoma of the ovary. Gynecol Oncol 1977;5:305e7. [4] Agnello G, Perri G, Cocilovo G. Malignant metastatic ovarian melanoma: a case report. Eur J Gynaecol Oncol 1981;2:119e20. [5] Nanu VK. Malignant metastatic ovarian melanoma e an unusual case-report. Br Med J 1985;290:606. [6] Stjernholm J, Borup K. Malignant melanoma with ovarian metastases. Ugeskr Laeger 1991;153:3330e1. [7] Meier HM, Geisler T. Ovarian metastasis of malignant melanoma e case report. Zentralbl Gynakol 1995;117:323e6. [8] Bilgin T. Late ovarian metastases of a cutaneous malignant melanoma. J Obstet Gynaecol 2000;20:323. [9] Santeusanio G, Ventura L, Mauriello A, Carosi M, Spagnoli LG, Maturo P, et al. Isolated ovarian metastasis from a spindle cell malignant melanoma of the choroid 14 years after enucleation e prognostic implication of the
[12]
[13]
[14] [15]
[16] [17] [18] [19]
keratin immunophenotype. Appl Immunohistochem Mol Morphol 2000;8: 329e33. Oliver R, Dasgupta C, Coker A, Al-Okati D, Weekes AR. Ovarian malignant melanoma: unusual presentation of a solitary metastasis. Gynecol Oncol 2005; 99:412e4. Al-Shehabi Z, Al-Soufi L. Metastatic ovarian tumor (Krukenberg’s tumor) from primary malignant melanoma of the skin: a case report. Mod Pathol 2006;19:40. Boutis A, Valeri R, Korantzis I, Valoukas D, Andronikidis I, Andreadis C. Delayed malignant melanoma recurrence simulating primary ovarian cancer: case report. World J Surg Oncol 2008;6:124. Abe Y, Takeuchi M, Matsuzaki K, Uehara H, Furumoto H, Nishitani H. A case of metastatic malignant melanoma of the ovary with a multilocular cystic appearance on MR imaging. Jpn J Radiol 2009;27:458e61. Fenzl V, Prkacin I, Skrtic A. Malignant melanoma ovarian metastasis mimicking acute tuboovarian abscess. Eur J Gynaecol Oncol 2011;32:582e4. Sbitti Y, Fadoukhair Z, Kadiri H, Oukabli M, Essaidi I, Kharmoum S, et al. Diagnostic challenge for ovarian malignant melanoma in premenopausal women: primary or metastatic? World J Surg Oncol 2011;9:65. Habek D, Marton I, Bauman R, Prka M, Bobic MV. Ruptured ovarian metastatic malignant melanoma caused acute abdomen. Cent Eur J Med 2012;7:241e4. Berisavac M, Kotlica BK, Pilic I, Atanackovic J. Metastatic malignant ovarian melanoma e a case report. Vojnosanit Pregl 2013;70:229e32. Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg 1995;181:193e201. National Comprehensive Cancer Network. NCCN clinical practice guideline in oncology, melanoma (Version 4, 2014). URL: http://www.nccn.org/ professionals/physician_gls/pdf/melanoma.pdf; 2014 [Accessed 23.07.14].