Melanoma metastases: brain and spine

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presented with left sided severe hemiparesis, hemineglect and Dejerine-Rousy syndrome.

Patient Data

Age: 64
Gender: Male
CT

CT Brain

There is a large nodular hyperdense well-defined right parietal mass surrounded by vasogenic oedema and promoting local mass effect with compression of the posterior horn of the right lateral ventricle. The lesion shows a peripheric and irregular enhancement. Other two small similar lesions are identified in the left frontal lobe and in the inferior aspect of the left cerebellar lobe. 

MRI

MRI Spine

MRI images show a sacral mass involving the left foramina at S2 and S3 levels and compressing the respective nerve roots. The mass is T1 hypointense and demonstrates a heterogeneous peripheral contrast enhancement which delineates a probable necrotic center. 

Pathology

MICROSCOPIC DESCRIPTION: 1&2. Paraffin sections show fragments of a densely hypercellular tumour. Tumour cells have markedly pleomorphic round oval and angulated vesicular nuclei many with conspicuous nucleoli and a variable amount of pale cytoplasm. The cytoplasm of scattered cells contains finely granular and globular black/brown pigment. Frequent mitotic figures are identified and there are several foci of tumour necrosis. Tumour is sharply demarcated from a narrow rim of adjacent included brain parenchyma. Immunohistochemistry shows strong nuclear staining for SOX-10 in >90% of tumour cells. No staining for tyrosinase, melan A, HMB-45, GFAP, TTF-1, BER-Ep4, or cytokeratins (AE1/AE3, CK20, CK7) is seen in tumour cells. The features are of metastatic malignant melanoma. DIAGNOSIS: 1&2. Parieto-occipital brain tumour: Metastatic malignant melanoma.

Case Discussion

This case illustrates a melanoma presentation due symptoms related to the metastatic disease. Melanoma is the third most common primary neoplasm that metastasizes to the brain.

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Case information

rID: 37089
Case created: 25th May 2015
Last edited: 24th Apr 2017
Tag: rmh
Inclusion in quiz mode: Included

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