Presentation
First presentation of seizures.
Patient Data
Multiple supratentorial subcortical lesions of variable size demonstrating confluent or ring enhancement and vasogenic edema.
Multiple pulmonary nodules and masses of varying size with lower zone predominance.
The left apical lesion has a microlobulared margin.
18G coaxial valved needle.
Heavily pigmented cores.
Histology:
DIAGNOSTIC SUMMARY: Lung: Metastatic melanoma.
Macroscopic Description: Labeled "lung biopsy", the specimen consists of eight dark brown hemorrhagic cores 5, 6, 7, 7, 9, 15, 15 and 18mm. All embedded. Block 1A- four longest cores; 1B- four shorter cores. [AW]
Microscopic Description: Lung. The multiple core biopsies, which consist virtually entirely of lesional tissue, show metastatic melanoma. The tumor is composed of sheets, cords and nests of intermediate to large epithelioid cells with a moderate amount of densely eosinophilic cytoplasm. There is moderate nuclear pleomorphism with some large rounded nuclei with prominent nucleoli. Some melanin pigment is noted in some tumor cells. Prominent sheets of heavily pigmented melanophages are present. Foci of tumor necrosis are noted. Mitotic activity appears brisk with in the order of 20 mitoses per square millimeter noted. Neither lymphovascular space invasion nor perineural invasion is noted. immunoperoxidase studies: S100: Positive SOX10: Positive MART-1: Positive HMB45: Positive BRAF v600e (IHC): Negative
Case Discussion
The diagnosis can be made from the appearance of the cores. A photo was sent to the referring physician who replied with a history of treated upper limb melanoma 11 years prior.
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