Melanoma metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Seizure.

Patient Data

Age: 75 years
Modality: CT

Hyperdense, haemorrhagic lesion in the posterior right frontal lobe with surrounding oedema. 

Modality: MRI

An enhancing haemorrhagic nodule is located within the posterior right frontal lobe, abutting the grey-white matter junction of the precentral sulcus in line with the the superior frontal sulcus. It is surrounded by subacute blood, both anteromedially and posterolaterally.

Surrounding it is a moderate amount of vasogenic oedema, with no evidence of non-enhancing tumour, which extends both into the frontal lobe and into the pre and post-central gyrus. MR spectroscopy in the region of high T2 signal adjacent to the lesion, is normal (not shown), with no elevation of choline. Cerebral blood volume appears elevated in the enhancing nodule, although given the presence of abundant blood products is unreliable. Similarly, a degree of restricted diffusion cannot be assessed.

There is only limited localised mass effect, with no distortion of the ventricles or midline shift. The posterior fossa is unremarkable, and this is an isolated abnormality.

Conclusion: Solitary enhancing haemorrhagic lesion with surrounding haematoma and vasogenic oedema has the differential diagnosis of haemorrhagic metastasis (which is favoured, particularly melanoma, lung and other classically haemorrhagic lesion such as thyroid and renal cell carcinoma) or haemorrhagic glioblastoma, which is thought substantially less likely.

Case Discussion

The patient went on to have surgery and excision. 

Histology

MICROSCOPIC DESCRIPTION: The sections show features of malignant epithelioid tumour. The tumour forms sheets with adjacent large areas of haemorrhagic necrosis. The tumour cells have enlarged pleomorphic nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. No brown pigment is seen in their cytoplasm. No evidence of lymphovascular invasion is noted. The tumour cells are melan-A and SOX10 positive. The features are those of metastatic melanoma.

FINAL DIAGNOSIS: Metastatic melanoma.

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Case Information

rID: 48178
Case created: 23rd Sep 2016
Last edited: 19th Nov 2016
Inclusion in quiz mode: Included

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