Presentation
Two week history of expressive dysphasia.
Patient Data
Large parenchymal hematoma at the left posterior temporal lobe with surrounding vasogenic edema. It is of predominantly T2 hyperintense appearance with a smaller rounded T2 hypointense component inside the hematoma. Localized sulcal effacement and compression of the left temporal and occipital horns of the lateral ventricle. No evidence of midline shift.
Conclusion: Despite the lack of appreciable enhancement of the parenchymal hematoma, the appearance suggests a hemorrhage into a lesion, most likely a hemorrhagic metastasis.
Case Discussion
This patient had a known history of previously excised melanoma.
Left posterior temporal craniotomy was performed for excision of the hemorrhagic lesion.
Histology
Sections are of a tumor comprising sheets of discohesive epithelioid cells with abundant pale grey cytoplasm, pleomorphic nuclei, coarse chromatin and prominent nucleoli. Many tumor cells have abundant fine to granular intracytoplasmic brown pigment and intranuclear inclusions. Numerous mitoses and apoptoses are present.
FINAL DIAGNOSIS: Metastatic melanoma.
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