Ruptured ovarian metastatic malignant melanoma caused acute abdomen

Abstract

Ovarian metastatic malignant melanoma is a rare form of disseminated malignant melanoma. We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), one year after osteoplastic parietal craniotomy for removal of recidiv metastatic lesions, and excision of the cutaneous malignant melanoma lesion on the upper leg were performed. During laparotomy because of acute abdomen, 4 L of free liquid (blood and ascites) were evacuated. The right adnexal mass was loose tumor, size 110x75 mm, with rupture on the posterior wall and hemorrhage. Unilateral adnexectomy was performed. Pathohystologic evaluation revealed tumor cells with eosinophilic, clear cytoplasm, intracytoplasmatic melanotic pigment and a great number of mitosis.Immunohistochemical results supported positivity for protein S-100, whereas results for cytoceratin 7, cytoceratin 20, pancytoceratin, epithelial membrane antigen and HMB-45 were negative. Three months after the surgery the patient died due to disseminated cerebral melanoma. An adnexal mass and the history of previous MM should be suspected to be ovarian metastatic malignant melanoma and the patient should be seen by gynecologist at least for active treatment.