PMC4896104_01
56-year-old woman with sinonasal amelanotic melanoma. Composite PET/CT image (sequence: CT, PET, Fused PET/CT in the coronal, sagittal and axial projections) shows a high metabolic lesion within the left nasal cavity extending to the left ethmoid sinuses (crosshair).
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A preoperative F-18 FDG PET/CT staging study confirmed the hypermetabolic left SMM (Figure 1).
56-year-old woman with sinonasal amelanotic melanoma. Anterior MIP PET image shows, in addition to the left sinonasal melanoma, diffuse foci of abnormal F-18 FDG uptake at the entire spine, shoulder and pelvic girdles, and long bones of extremities related to diffuse osseous metastases.
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It also showed diffuse foci of abnormal radiotracer uptake in the axial and appendicular skeleton compatible with diffuse osseous metastasis (Figure 2). The tumor showed about 20 mitotic figures per mm2 with strong positivity for HMB 45 and Melan-A.
56-year-old woman with sinonasal amelanotic melanoma. Sagittal T1-weighted MR image of the thoracic spine, obtained 3 weeks after sinonasal surgery, shows diffuse abnormally decreased signal intensity of the bone marrow comparing to the signal intensity of adjacent vertebral disks. There is prevertebral and retrocrural adenopathy (arrows), which was not present on initial PET/CT examination.
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Spine MR examination, performed three weeks after PET/CT, showed diffuse bone marrow signal intensity changes from osseous tumor infiltration and detected new prevertebral adenopathy not seen on initial PET/CT (Figure 3).
56-year-old woman with sinonasal amelanotic melanoma. Axial CT image of the abdomen, obtained 3 weeks after sinonasal surgery, shows diffuse metastases involving the liver, peritoneum and retroperitoneum (arrows).
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CT, following the MR examination, showed diffuse tumor dissemination to lungs, liver, mesentery, peritoneum and retroperitoneum, and bilateral malignant pleural effusion (Figure 4).