Melanoma metastasis

Case contributed by Assoc Prof Frank Gaillard

Presentation

Headache

Patient Data

Age: 65 years
Gender: Male
CT

A large hemorrhagic mass is seen in the frontal lobe on the right with enhancement and surrounding vasogenic edema. 

MRI

There is a large solitary mass at the grey-white matter junction of the right frontal lobe which demonstrates heterogeneous T1 and T2 signal with a large amount of intrinsic T1 hyperintensity particularly inferiorly and posteriorly. There is a large amount of hemosiderin staining. The lesion demonstrates irregular enhancement. It is surrounded by white matter T2/FLAIR hyperintensity surrounding the mass which spares the cortex. This extends into the genu of corpus callosum.

The mass demonstrates elevated CBV. MRS is non-contributory. 

Conclusion:

Large hemorrhagic right frontal mass is favored to represent a metastasis, for example melanoma. 

Case Discussion

This patient had a past history melanoma (three years earlier) making this the likely diagnosis. He went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: Paraffin sections show a densely hypercellular tumor. Tumor cells have markedly pleomorphic round and oval vesicular nuclei with conspicuous nucleoli and a variable amount of pale cytoplasm. These are arranged in diffuse sheets within a vascular stroma. Frequent mitotic and apoptotic figures are identified and there is extensive tumor necrosis. Tumor cells show strong immunostaining for tyrosinase and Sox 10. No staining for TTF-1, carcinoembryonic antigen (CEA), pancytokeratin AE1/AE3 or for cytokeratins CK7 and CK5&6 is seen in tumor cells. The features are of metastatic malignant melanoma.

FINAL DIAGNOSIS: Metastatic malignant melanoma.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.