PMC4331473_01
Technique. Axial images were obtained from the lower chest to the pubic symphysis with intravenous and oral contrast. Patient received 125 milliliters of Omnipaque 350 as a contrast agent. Findings. Lymph nodes: a necrotic appearing, enlarged right inguinal lymph node is noted, measuring 5.0 x 7.1 cm (blue arrow). Multiple other right inguinal lymph nodes are noted, borderline in size. An enlarged right external iliac lymph node is seen on measuring 2.0 x 1.5 cm. A mildly enlarged 1.5 x 1.1 cm right external iliac lymph node is seen just posterior to this. Nothing abnormal is detected in abdomen or pelvis worthy to mention.
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fig1
CT scan of the abdomen and pelvis with oral and IV contrast was done (Figure 1) and showed necrotic appearing, enlarged right inguinal lymph node, measuring 5.0 x 7.1 cm.
(a) Metastatic melanoma replacing a lymph node with a thin rim of residual lymphocytes (far right) H&E 5x. (b) The malignant cells are strongly positive for Melan A, (c) positive for HMB45, and (d) negative for cytokeratin AE1/AE3 (IHC, 5x). Although this staining pattern could be seen in benign and malignant melanocytes, its presence in a lymph node indicates metastasis.
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Pathology came back with malignant melanoma (Figures 2(a), 2(b), 2(c), and 2(d)).