Melanoma cerebral metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Right upper limb partial seizure.

Patient Data

Age: 65
Gender: Male
CT

Pre and post contrast scans of the brain have been performed. The 2.2 cm haemorrhagic right frontal mass. There is a moderate amount of adjacent oedema with local mass-effect. No other focal abnormality identified.

MRI

Within the right frontal lobe (precentral gyrus) is a rounded lesion measuring 1.5 cm in diameter with heterogeneous signal including blood products, and vivid heterogeneous contrast enhancement. It is surrounded by a significant amount of vasogenic oedema, sparing the cortex. It is an isolated abnormality. Ventricles are unremarkable.

Conclusion:

Right frontal lobe lesion has imaging appearances consistent with a melanoma metastasis or other haemorrhagic metastasis. 

Case Discussion

The patient went on to have a craniotomy. 

Histology

MICROSCOPIC DESCRIPTION: The section shows fragments of a densely hypercellular tumour and fragments of blood clot and granulation tissue containing collections of haemosiderin filled macrophages. Tumour cells have pleomorphic vesicular nuclei many with conspicuous nucleoli and a variable amount of pale cytoplasm. Finely granular black-brown pigment is noted within the cytoplasm of many tumour cells. There are frequent mitotic figures and foci of tumour necrosis are also noted. Tumour cells show strong immunostaining for tyrosinase. The features are of metastatic malignant melanoma.

FINAL DIAGNOSIS: Metastatic malignant melanoma.

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Case information

rID: 30409
Case created: 8th Aug 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

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