Melanoma metastases: brain

Case contributed by A.Prof Frank Gaillard

Presentation

Right sided hemiparesis

Patient Data

Age: 45 years
CT

Two lesions are identified, one centered within the left lentiform nucleus and the other within the posterior left temporal lobe at the grey-white matter junction. Both lesions are predominantly hyperdense, with layered internal fluid density in the left basal ganglia lesion likely related to internal haemorrhage. There is mild associated surrounding oedema and minor mass-effect with slight bowing of the septum pellucidum but no significant midline shift and no uncal or transtentorial herniation.

Right cerebellar encephalomalacia is noted adjacent to craniotomy site. 

MRI

Multiple lesions are seen in the supratentorial brain with T1 isointense and T2 hyperintense signal that demonstrate post contrast enhancement and susceptibility blooming. 

  • large left hemispheric masses
    • left basal ganglia demonstrates intralesional blood layering & left posterosuperior temporal lobe also demonstrates intralesional blood layering
    • these lesions are surrounded by FLAIR hyperintensity in keeping with vasogenic oedema
  • multiple smaller supratentorial lesions (superior to the left caudate nucleus, right medial frontal lobe, enhancing focus applied to brain surface in the left postcentral sulcus)
  • right cerebellopontine angle (two extraaxial vividly enhancing lesions; applied to the right lateral aspect of the cerebellopontine angle and a second lobulated lesion with components inside the right IAM and extending in linear fashion along the petrous apex with a further nodular portion bulging into the prepontine cistern)

Case Discussion

This patient had known BRAF positive melanoma first on L) thigh with known metastases to spine, skin, liver and lung and posterior fossa (resected). Initially responsive to BRAF inhibitors however recently has shown progression.

 

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Case information

rID: 45137
Case created: 16th May 2016
Last edited: 8th Jun 2016
Inclusion in quiz mode: Included

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