A 24-year-old woman, drugdict, HIV-negative, with history of nodular pulmonary infiltrates for 9 months with clinical diagnosis of possible granulomatosis.
The patient had a 1-month history of fever and abdominal pain due to a right adnexal mass.
On examination, a 12 cm right ovarian mass was observed, together with a 2 cm transverse colon mesome that was removed.
Simultaneously, the patient reported a 4 cm tumor in the right thigh, located in the depth of the subcutaneous cellular tissue.
The ovarian tumor and the mesenteric nodule had a lobulated external surface, whose section surface showed solid and cystic areas.
In the ovary, the predominant epithelioid morphology of the cells was prominent with diffuse growth pattern, with small cystic spaces or pseudofoli
In the mesenteric nodule, fusocellular morphology predominated.
Alternative hypercellular and hypocellular areas were observed.
There were extensive and frequent areas of geographic necrosis with a tendency to preserve those tumor cells surrounding the vessels resulting in a periteliomatous pattern.
The greater the increase, the fusiform tumor cells show the non-prominent melanoma.
More than 10-20 mitosis was observed in 10 high-power fields.
Immunophenotyping revealed vimentin, S-100, HMB-45 and actin.
S-100 staining was intense and diffuse.
The tumor did not express epithelial markers or other markers such as CD 117, CD 68, CD 99, collagen IV, estrogen receptors, progesterone receptors and inhibine.
The posteriorly excised thigh tumor was unrelated to the epidermis and histologically was superimposable to the ovarian tumor.
The distribution of the tumor nodules, the combination of histological patterns and the immunohistochemical profile was consistent with the diagnosis of metastatic malignant melanoma, arising on a primary tumor of unknown origin and no worrying regression of the lesion was found.
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The patient was treated with chemotherapy (Cisplatin, Interleukin II, Dacarbacin and Interferon alfa) and 3 months later, she died of multiple contralateral abdominal metastases, including multiple ovarian masses.
