Presentation
Injured neck 2 months ago, complains pain since then, not improving.
Patient Data
Osteo-destruction of C2 vertebral body including odontoid with associated pre vertebral soft tissue swelling, highly suspicious of aggressive lesion - metastasis
There is permeative osteo-destruction of C2 vertebral body including odontoid and left posterior elements, associated with soft tissue component showing spinal canal extension and causing compression of cervical cord at this level - metastasis.
There is associated pathological fracture-displacement, resulting in left lateral subluxation of cervical spine at C1/C2 level.
Similar osteo-destructive focus is noted involving left pediculo-laminar and transverse process of C4 vertebra.
Multiple subcutaneous and bony lesions in keeping with widespread metastatic disease. Osteo-destruction at C2/3 level with the larger mass lesion causing cord myelopathic change and malignant cord compression.
Multiple bilateral pulmonary nodules and mass, largest at left lower lobe with mediastinal and hilar lymphadenopathy. Multiple Liver metastases. Multiple subcutaneous nodules throughout. Bony metastases.
No brain metastasis. Subcutaneous nodule at right parietal region of scalp.
Case Discussion
The case was discussed in MDM, managed acutely for cervical spine instability and cord compression. There was an history of malignant melanoma excision 6years back, lost follow up. The present condition is diagnosed as metastatic melanoma after core needle biopsy from right chest wall lesion.