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LETTER TO THE EDITOR
Year : 2011  |  Volume : 7  |  Issue : 1  |  Page : 96-97

Primary malignant melanoma presenting as FDG avid large necrotic splenic mass with metastatic retroperitoneal adenopathy: FDG-PET and histopathological correlation


1 Radiation Medicine Centre (BARC), Tata Memorial Hospital, Jerbai Wadia Road, Parel, Mumbai, Maharashtra, India
2 Department of Pathology, Tata Memorial Hospital, Jerbai Wadia Road, Parel, Mumbai, Maharashtra, India

Date of Web Publication5-May-2011

Correspondence Address:
Sandip Basu
Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.80451

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How to cite this article:
Basu S, Jambhekar NA. Primary malignant melanoma presenting as FDG avid large necrotic splenic mass with metastatic retroperitoneal adenopathy: FDG-PET and histopathological correlation. J Can Res Ther 2011;7:96-7

How to cite this URL:
Basu S, Jambhekar NA. Primary malignant melanoma presenting as FDG avid large necrotic splenic mass with metastatic retroperitoneal adenopathy: FDG-PET and histopathological correlation. J Can Res Ther [serial online] 2011 [cited 2019 Dec 16];7:96-7. Available from: http://www.cancerjournal.net/text.asp?2011/7/1/96/80451

Sir,

We herein report FDG-PET imaging characteristics of primary splenic melanoma, an extremely rare entity in routine clinical scenario. A 56-year-old male presented with anorexia, weight loss, and left upper quadrant pain of 3 months duration. An ultrasonography of the abdomen revealed a moderate-sized heterogeneously echogenic lesion in the left upper abdomen arising from the spleen, the differential diagnosis was hemangioma and neoplastic lesion. The computed tomography of the abdomen demonstrated 13 × 11 × 15 cm 3 heterogeneously enhancing hypodense splenic mass with retroperitoneal and peripancreatic lymphadenopathy. Whole body FDG-PET [Figure 1]a and b showed a large mass of avid FDG uptake with extensive zone of photopenia suggesting necrosis. There was evidence of adjacent retroperitoneal adenopathy as well. In addition, there was a tiny intense focus in a right peribronchial node. CT-guided fine needle aspiration cytology of the spleen revealed pigmented malignant melanoma [Figure 2] and [Figure 3]. Because of the rarity of the entity, a colonoscopy was carried out, which was not suggestive of any gut involvement. The patient was subsequently put on chemotherapy (cisplatin, dacarbazine, and interferon) but demonstrated progressive disease.
Figure 1: (a and b): Whole body FDG-PET (a, MIP image and b, coronal slices) carried out 60 min after the intravenous injection of 300 MBq of 18F-FDG shows a large mass of avid FDG uptake with an extensive zone of photopenia suggesting necrosis. There is evidence of adjacent retroperitoneal adenopathy. In addition, there is a tiny intense focus in a right peribronchial node

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Figure 2: Smear shows pleomorphic cells with prominent nucleoli, multinucleation, and coarse brown black pigment are seen in aspirate

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Figure 3: Cohesive clusters of pleomorphic cells with pigment are seen on FNAC (Papanicolau: 200×). Extracellular pigment was also seen. Overall the cytomorphology was consistent with a diagnosis of pigmented malignant melanoma

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Only 4-5% of all primary melanomas originate from the extracutaneous sites. [1],[2] In a comprehensive review, they were most frequently found to originate from the mucous membranes lining the respiratory, digestive, and genitourinary tracts or in the eyes as well as in the cerebral meninges. [1] Clinically, they appear to run an aggressive course and the therapeutic strategies are relatively less defined in this scenario. Primary splenic melanoma is extremely unusual to encounter and is presented here as interesting case vignette to emphasize the fact that it is FDG avid and hence, FDG-PET imaging can be utilized to monitor disease activity in this setting. This patient also had an aggressive clinical course and died of the disease within 1 year of the diagnosis despite prompt initiation of chemotherapy.

 
 > References Top

1.Thoelke A, Willrodt S, Hauschild A, Schadendorf D. Primary extracutaneous malignant melanoma: A comprehensive review with emphasis on treatment. Onkologie 2004;27:492-9.  Back to cited text no. 1
    
2.Peter RU, Landthaler M, Braun-Falco O. Extracutaneous malignant melanomas: Clinical aspects and biology. Hautarzt 1992;43:535-41.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
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Aisheng Dong,Yang Wang,Jianping Lu,Changjing Zuo
Clinical Nuclear Medicine. 2014; 39(4): 339
[Pubmed] | [DOI]



 

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