Intracranial metastatic melanoma

Case contributed by Jose Roberto Montañez Sauceda

Presentation

Previously known as right papillary adenocarcinoma of the retinal pigmented epithelium by histopathology. The condition started a year before with decreased visual acuity of the right eye accompanied by ocular pain in the same eye.

Patient Data

Age: 50 years
Gender: Male

Sagittal T1-weighted projection shows enucleation of the oculi globe and with the presence of a mass in the ipsilateral nasolacrimal duct, with hypointense behavior on T1, isointense on T2/FLAIR.

DWI and ADC projections show no diffusion restriction.

Said lesion shows apparent superior extension towards the nasolacrimal duct and the floor of the orbit, eroding the latter; as well as a posterior extension towards the right maxillary sinus with infiltration of the same.

Intraventricular and infundibular pituitary lesions are documented in relation to metastatic tumor activity.

Case Discussion

The incidence of central nervous system (CNS) metastases in patients with melanoma ranges from 10% to 40% in clinical studies and is even higher in autopsy series with as many as two-thirds of patients with metastatic melanoma having CNS involvement.

This case shows post-surgical changes in the right orbit with the presence of a lesion in relation to residual tumor activity of a known primary tumor; likewise, intraventricular and infundibular pituitary lesions are associated with metastatic tumor activity.

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