Melanoma metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Headache

Patient Data

Age: 65 years
Gender: Male
CT

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

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 haemosiderin 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 favoured 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 tumour. Tumour 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 tumour necrosis. Tumour 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 tumour cells. The features are of metastatic malignant melanoma.

FINAL DIAGNOSIS: Metastatic malignant melanoma.

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Case information

rID: 43395
Case created: 8th Mar 2016
Last edited: 19th Jun 2016
Inclusion in quiz mode: Included

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