PMC6739717_01
Brain magnetic resonance imaging (MRI) and thoraco-abdominopelvic computed tomography (CT). a Normal axial T2-weighted MRI scan with a thalamic window. b Normal sagittal T1-weighted scan with gadolinium with a midbrain window. c CT of the thorax without contrast, mediastinal window, a small area of consolidation in both hemithorax with left predominance; this consolidation was accompanied by air bronchogram. d CT of the thorax with a lower (basal) plane, where volume asymmetry is observed favoring the right hemithorax, as well as bilateral ground-glass opacities with right predominance. e Normal coronal reconstruction of thoraco-abdominopelvic CT with contrast. f Normal sagittal thoraco-abdominopelvic CT with contrast.
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F1
Screening for a neoplastic process in the brain, magnetic resonance imaging (Fig. 1a, b) was performed, reporting normal results. In search of a primary site simple and contrasted thoracic, abdominal, and pelvic CTs were performed (Fig. 1c-f). The CT of the thorax showed lung parenchyma with areas of consolidation and images compatible with ground glass opacities and air bronchogram (Fig. 1c, d).
Histopathology. a Axillary ganglion. Hematoxylin and eosin staining. x50. High-grade and poorly differentiated malignancy. b Axillary ganglion. Hematoxylin and eosin staining. x100. Poorly differentiated malignant neoplastic lesion constituted by pleomorphic cells, atypical nuclei with open chromatin, nuclear pseudo-inclusions, and mitosis. c-f Axillary ganglion. x100. Histopathological diagnosis compatible with melanoma. c Melan-A staining positive. d HMB-45 staining positive. e Vimentin staining positive. f S-100 staining positive.
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F2
An axillary ganglion biopsy was performed reporting a high-grade and poorly differentiated malignancy (Fig. 2a, b). The histopathological diagnosis was compatible with melanoma (Fig. 2c-f). The histological sections of the axillary, paratracheal and perihilar lymph nodes showed a poorly differentiated malignant neoplastic lesion constituted by pleomorphic cells, atypical nuclei with open chromatin, nuclear pseudo-inclusions, and mitosis (Fig. 2a, b, 3c, d). Immunohistochemical staining was performed and antibodies for HMB-45, melan-A, vimentin, and S-100 were positive (Fig. 2c-f).
Necropsy of the brain and lungs. Histopathology of paratracheal and perihilar lymph nodes. a Necropsy of the brain. Coronal brain with hemorrhagic lesions at the corpus callosum level. b Necropsy of the lungs. Paratracheal and perihilar lymph nodes with sizes ranging from 0.8 x 0.5 cm to 1.5 x 1.2 cm, firm, with solid surface and abundant dark pigment. c Histopathology of paratracheal and perihilar lymph nodes. Hematoxylin and eosin staining. x100. Poorly differentiated malignant neoplastic lesion with nuclear pseudo-inclusions and mitosis. d Histopathology of paratracheal and perihilar lymph nodes. Hematoxylin and eosin staining. x150. Poorly differentiated malignant neoplastic lesion with nuclear pseudo-inclusions and mitosis.
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F3
Necropsy examination was performed by two independent pathologists reporting hemorrhagic lesions at the corpus callosum level, multiple paratracheal and perihilar lymph nodes (e.g. sizes ranging from 0.8 x 0.5 cm and 1.5 x 1.2 cm) (Fig. 3). The histological sections of the axillary, paratracheal and perihilar lymph nodes showed a poorly differentiated malignant neoplastic lesion constituted by pleomorphic cells, atypical nuclei with open chromatin, nuclear pseudo-inclusions, and mitosis (Fig. 2a, b, 3c, d).