Breast metastases from facial malignant melanoma

Case contributed by Dr Ammar Haouimi

Presentation

This patient under chemotherapy for a facial malignant melanoma. The physical exam revealed multiple palpable masses in the breasts as well as the thoracic and abdominal wall.

Patient Data

Age: 60 years
Gender: Female

Bilateral breast masses are seen, right larger than left with hypodense central necrotic areas. Multiple and bilateral lobulated masses of both axillary regions suggestive of enlarged lymph nodes.

Another soft tissue mass is seen in the left costovertebral region encasing the descending thoracic aorta as well as the segmental and subsegmental bronchi of the left lower lobe with mass effect on the heart cavities.

Multiple subcutaneous and intramuscular nodules of the chest / abdominal wall and in front of the spinous process of T11 as well as a large soft tissue mass of the right scapular region.

Large soft tissue mass of the left paraspinal muscles extending up to L4 level.

Note a large soft tissue mass of the left lower chest wall invading the pleura.

Bilateral pulmonary embolism involving the right pulmonary artery and left lobar arteries with extension into the segmental branches.

Multiple and bilateral pulmonary nodules, the largest in the right lower lobe.

Multiple intra-peritoneal nodules seen in perihepatic region and intramesenteric, the largest is in the pelvic region. Multiple necrotic enlarged lymph nodes seen in the left external iliac and inguinal regions. Retroperitoneal enlarged lymph nodes at the renal hilum displacing the left renal vein anteriorly and compressing the renal pelvis with dilatation of the calyceal cavities.

No bone metastases.

Case Discussion

A case of ubiquitous metastases from malignant facial melanoma to both breasts, lung, pleura, peritoneum, lymph nodes,soft tissues of the thoracic/abdominal- pelvic wall with pulmonary embolism).

Malignant melanoma is one of the most rapidly increasing cancer in the world. Metastases to the breast represent an uncommon site from malignant melanoma or other extra-mammary tumors and represent 1.3–2.7% of all malignant breast tumors(1).Lymphomas / leukemia, melanomas, rhabdomyosarcomas, lung, prostate, and ovarian tumors are the most commonly reported tumors metastasizing to the breast.(1,2,3,4). The most frequent source of a breast metastasis is a contralateral breast tumor (4,5)

The diagnosis of breast metastases from malignant melanoma, especially if bilateral lesions, requires a whole body evaluation because in most cases indicate a widespread disease(1). For this reason we should lead to avoid aggressive surgical procedures because of the poor prognosis(1)

 

Additional Contributors: R. Bouguelaa MD, C. Boukaaba MD

 

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Case information

rID: 60316
Published: 19th May 2018
Last edited: 16th Jan 2019
System: Head & Neck
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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