|IMAGE IN HEMATOLOGY
|Year : 2019 | Volume
| Issue : 2 | Page : 73-74
Metastatic malignant melanoma in the bone marrow with occult primary
Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College Perinthalmanna, Kerala, India
|Date of Web Publication||10-Jul-2019|
Prof. Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College, Perinthalmanna - 679 338, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abdulla MC. Metastatic malignant melanoma in the bone marrow with occult primary. J Appl Hematol 2019;10:73-4
A 33-year-old housewife was admitted with low back pain for 2 months. Examination showed mild hepatosplenomegaly. Hemoglobin was 6.4 g/dL, white blood cells 4.720 × 109/L, and platelet count 0.34 × 109/L. Peripheral blood smear showed leukoerythroblastic blood picture with moderate thrombocytopenia. Magnetic resonance imaging of the spine showed hyperintense lesions involving D6 and D9 vertebral bodies in the T1-weighted images [[Figure 1]a upper panel]. Contrast-enhanced computed tomography of the abdomen showed multiple hypodense lesions in the liver and splenomegaly. Bone marrow aspiration yielded a viscous mixture with brownish clumps. The marrow was replaced by neoplastic cells, which were intermediate sized with enlarged irregular nucleus, inconspicuous nucleoli, and scanty cytoplasm with heterogeneous dark-brown granules [[Figure 1]b upper panel]. Bone marrow biopsy immunochemistry was positive for human melanoma black 45 (scattered cells) and S100 (diffuse) [[Figure 1]c and [Figure 1]d lower panel]. An extensive evaluation did not reveal a primary site, and the patient died before initiation of chemotherapy.
|Figure 1: (a) Magnetic resonance imaging of the spine showing hyperintense lesions involving D6 and D9 vertebral bodies in the T1-weighted images. (b) Bone marrow showing neoplastic cells with enlarged irregular nucleus, inconspicuous nucleoli, and scanty cytoplasm with heterogeneous dark-brown granules (H and E stain, ×40). (c and d) Bone marrow immunochemistry showing positivity for human melanoma black 45 (scattered cells) and S100 (diffuse)|
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Bone marrow infiltration in melanoma is rare, occurring in 5% of patients with disseminated disease but in up to 45% when an autopsy-staging procedure is performed. T1 hyperintense vertebrae lesions on magnetic resonance imaging are mostly benign except malignant melanoma metastasis. Metastatic involvement of the bone marrow by melanoma with an occult primary has been reported rarely. Partial regression of the primary site is a common feature in melanoma. Total regression is rare but can occur after nodal and distant metastases. The case reminds the readers of a rare presentation of malignant melanoma involving the bone marrow and highlights the importance of considering melanoma metastases in the differential diagnosis of T1 hyperintense vertebrae lesions on magnetic resonance imaging.
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