PMC6417341_01
Computed tomography brain plain scan images (a) show cortical-based hyperdense lesion in the right parietal region with bleed. Magnetic resonance brain T2W axial (b and c) and coronal (d) images show right parietal cortical-based isointense lesion with bleed. T1W axial (e-g) shows lesion with bleed. Fluid-attenuated inversion recovery image (h) shows hyperintensity. Diffusion-weighted images image (i) shows peripheral restriction of the lesion and susceptibility-weighted images (j) images show intense susceptibility. Fat saturated T1W contrast axial (k) and sagittal (l) images show contrast enhancement of the lesion. Magnetic resonance angiography (m) shows normal flow signals
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F1
It was associated with bleed measuring 48 mm x 38 mm. [Figure 1a] Magnetic resonance imaging (MRI) showed well-circumscribed, lobulated, cortical-based lesion with bleed in the right parietal region. No other abnormality was seen [Figure 1b-m].
Intraoperative picture (a) shows lesion on the pial surface and (b) shows gross specimen. Postoperative computed tomography brain plain (c), Magnetic resonance T2W and T1W axial (d and e) images show total evidence of lesion and evacuation of hematoma.
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F2
Postoperative period was uneventful. Postoperative CT and MRI showed total excision of lesion with bleed [Figure 2c-e].
(a) Shows papillaroid arrangement of polygonal tumor cells with hyperchromatic nuclei and scant intracytoplasmic pigment in most of the areas. The melanin pigment is highlighted on Masson-Fontana stain (inset). (b) Shows a focus with intracytoplasmic brownish-black pigment within the macrophages and possibly few tumor cells. (c and d) Tumor cells are labeled by human melanin black-45 (c) and S-100 (d), with a high proliferative index (MIB-1, inset) (A: H and E, A, inset: Fontana-Masson, B: H and E; C: human melanin black-45, Immunoperoxidase; D: S-100, D, inset: MIB-1, immunoperoxidase. Magnification = scale bar)
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F3
The tumor showed strong HMB-45 immunopositivity and the final diagnosis of MM was offered [Figure 3a-d].
Repeat computed tomography plain (a and b) after radiation therapy shows tumor with bleed. Magnetic resonance T2W axial images (c and d) show isodense tumor with bleed in the right occipital region, axial (e), sagittal (f), and coronal contrast images (g and h) show recurrent contrast-enhancing tentorium-based occipital tumor (large arrows) and small arrows show previous operated cavity. Intraoperative pictures (i and j) show the gross specimen. Postoperative computed tomography plain (k and l) shows complete excision of the tumor
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F4
CT brain showed right parietooccipital bleed [Figure 4a and b]. Imaging confirmed a recurrent tumor remote from the previously operated site and away from the leptomeninges [Figure 4c-h]. Tumor was soft and suckable mixed with blood clots [Figure 4i and j]. Postoperative CT confirmed total excision [Figure 4k and l] and histopathology confirmed HMB-45 strongly positive recurrent melanoma.