PMC3863512_01
(a), (b), (c) Arrows showing MRI of brain with and without gadolinium with metastatic lesions in parietal and occipital region. (d) Showing CT scan of abdomen and pelvis with filling defect in terminal ileum.
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A magnetic resonance imaging (MRI) (Figures 1(a), 1(b), and 1(c)) scan of the brain revealed four enhancing brain masses largest in the right parietal lobe and others in right frontal and temporal lobe and left parietal lobe, respectively. Further staging workup included examinations of the eyes, head, and neck mucosa, total skin, gynecological evaluation, bone scintigraphy, and computed tomography (CT) scans of abdomen and pelvis (Figure 1(d)) that showed a filling defect in terminal ileum as the only pathological finding.
(a) Showing colonoscopy view of mass in the terminal ileum. (b) Showing biopsy of the lesion.
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Colonoscopy revealed a partially pigmented polypoid lesion in the terminal ileum and a biopsy done was suggestive of malignant melanoma (Figure 2).
(a) Hematoxylin-eosin stain of melanoma in terminal ileum. (b) Hematoxylin-eosin stain of melanoma in terminal ileum, original magnification x400. (c) Specimen stained with c-kit immunohistochemistry, original magnification x400. (d) Specimen stained with HMB 45+ antibody original magnification x400.
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Further pathological evaluation revealed it as epithelioid variant with ulceration and negative for BRAF oncogene (Figure 3).