Melanoma metastases: brain and spine

Case contributed by Dr Bruno Di Muzio


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

Patient Data

Age: 64
Gender: Male

CT Brain

Modality: CT

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 Spine

Modality: MRI

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. 

Modality: 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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