Melanoma cerebral metastasis

Case contributed by Dr Bruno Di Muzio

Presentation

Confusion and headache.

Patient Data

Age: 57
Gender: Male

CT Brain

Modality: CT

Three nodular heterogeneous masses identified in the right parietal, left frontal and left temporal lobes associated with mass effect characterised by vasogenic oedema and displacement of adjacent structures. These lesions shows spontaneous hyperdensity and heterogenous contrast enhancement, the central areas are hypodense probably due necrosis. 

MRI Brain

Modality: MRI

Three nodular masses are again demonstrated with no signals of continuity between them, showing heterogeneous haemorrhagic component and contrast enhancement. 

The radiologic features favour the diagnosis of a metastatic disease. When considering the haemorrhagic component and the demographic data (Australian man) most probable primary tumours are melanoma and pulmonary carcinoma. GBM is less likely due the distribution as three apparently isolated lesions. 

Further investigation was proposed with CT Chest and CT Abdomen and pelvis. 

Modality: CT

Three solid nodular enhanced lesions were identified: in the left hemithorax an anterior juxtapleural nodule; a left sub diaphragmatic nodule and a right subcutaneous nodule in the lower portion of middle axillary line. 

Case Discussion

This case illustrates large brain haemorrhagic metastatic nodules that raise the possibilities for a malignant melanoma or a lung carcinoma (considering the most common haemorrhagic metastasis for this specific demographic data). Further body investigation with CT scan confirmed other metastasis foci, including one in the subcutaneous which theoretically established melanoma as the primary tumour. 

The diagnostic was pathologically proven as a scalp malignant melanoma.

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Case Information

rID: 37760
Case created: 22nd Jun 2015
Last edited: 10th Sep 2015
Tag: rmh
Inclusion in quiz mode: Included

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