Malignant melanoma arising in a dermoid cyst of the ovary

Autopsy findings of primary malignant melanoma arising in an ovarian dermoid cyst in an 86-year-old woman are presented. The right ovary was replaced by a dermoid cyst, 14 x 9 x 9 cm in size, in which several nodular tumors with diameters less than 3.2 cm were localized. They comprised diffusely proliferating anaplastic cells with prominent nucleoli. Some of them contained melanin pigments in the cytoplasm. The tumor cells were positive for S-100 protein and ultrastructurally showed melanosomes. In addition, several benign pigmented lesions resembling dermal nevus, pigmented schwannoma, or cellular blue nevus were present in the dermoid cyst, one of which contained a malignant melanomatous component. Histologic transition between benign and malignant components and the presence of another small focus of atypical melanocytes in the benign lesion suggested that the malignant melanoma arose in close association with the previously existing benign pigmented lesions in the dermoid cyst.