1/37. Imaging features of intraventricular melanoma.We present the MR imaging findings in a patient with symptoms of increased intracranial pressure and a mass in the left lateral ventricle. The mass showed increased signal intensity on T1-weighted images and low signal intensity on T2-weighted images. The histologic diagnosis was that of melanoma, and detailed physical and funduscopic examinations disclosed no evidence of a primary lesion. We believe that the mass was a primary intraventricular melanoma, possibly arising from the choroid plexus, and we discuss the mechanisms that may be responsible for its occurrence in this location.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/37. Malignant melanoma presenting as an intrathymic tumor: a primary thymic melanoma?The identification of malignant melanoma in a visceral organ of nonepidermal origin is not an uncommon occurrence. Frequently, these cases are solitary metastases that present years after a thin epidermal melanoma has been diagnosed (and sometimes forgotten). However, primary visceral melanomas have been reported that have not been preceded by an epidermal lesion. We describe herein a unique case of melanoma presenting as a primary intrathymic tumor. The patient had no previous history of epidermal melanoma, and extensive workup did not reveal evidence for an alternative primary site. The tumor exhibited histologic features characteristic of melanoma, including an abundance of large pleomorphic cells with eosinophilic cytoplasm, prominent nucleoli, and S100 protein and ultrastructural analysis revealed stage II and stage III melanosomes. The patient remained free of disease until intrathoracic recurrence was detected on a computed tomographic scan 14 months later. The lack of clinical history and physical findings of melanoma at presentation, the intrathymic location of the tumor, and the pattern of recurrence suggest that this case likely represents a primary thymic melanoma, a previously unreported entity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/37. melanoma-associated retinopathy versus abnormal retinal function due to interferon-alpha/isotretinoin therapy in cutaneous malignant melanoma.PURPOSE: To analyze whether an abnormal retinal function in patients with a cutaneous malignant melanoma was due to paraneoplastic retinopathy or due to isotretinoin or interferon-alpha. methods: We studied 15 patients with malignant melanoma in stage IIa and IIb who are all participants in a randomized, multicentered, double-blind placebo-controlled clinical trial comparing interferon-alpha/isotretinoin versus interferon-alpha/placebo performed by the Department of dermatology, University of Graz. Our assessment included a full ophthalmic history and examination, electrophysiological testing (ERG, EOG), dark adaption, color vision and visual field testing. RESULTS: The most prevalent ocular symptom patients complained about was ocular dryness (8 patients). Electrophysiological as well as psychophysical testings showed no abnormalities in 12 patients. In 1 patient the therapy was stopped because of electrophysiological and psychophysiological pathology. This patient suffered from severe reduction of night vision and visual disturbances. Another patient had had night blindness since childhood which remained stable. CONCLUSIONS: We postulate that in 1 of 15 patients, visual complaints are caused with a high probability by melanoma-associated retinopathy although, in the literature, isotretinoin is described to show similar effects on retinal function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/37. Metastasis of malignant melanoma in the small intestine. A case report.Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with fairly non-specific symptoms. A 63-year old man with previous enucleation of the left eye for a malignant coroidian melanoma presented signs of intestinal subocclusion. weight loss and a palpable mass deep on the paraumbilical left region were the significant physical signs. Because the state of the patient had worsened, the diagnosis was made by ultrasonography examination. Segmental intestinal resection with regional lymph node dissection was performed. Surgical resection can be performed safely as patients for whom all sites of disease are completely resected experience significant improvements in survival times, compared with patients who undergo an incomplete resection. For selected patients, surgical treatment of metastatic melanoma involving the gastrointestinal tract is appropriate therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/37. Vulvar malignant melanoma associated with human papillomavirus dna: report of two cases and review of literature.Oncogenic human papillomavirus (HPV) types such as HPV 16 are known to play a crucial role in the development of anogenital carcinomas. The etiology of anogenital malignant melanoma is unknown. We report two case of vulvar malignant melanoma in which multiple HPV types including HPV 16 and putative novel HPV types (alb-1, alb-2, alb-7, and alb-10) were identified by degenerated nested polymerase chain techniques (polymerase chain reaction) in both the malignant melanoma and surrounding skin. One melanoma was associated with lichen sclerosus, and the other, with melanoma in situ and pigmented vulvar squamous papillomatosis. These melanomas harbored HPV types alb-7, and HPV 16 as well as alb-1, respectively. HPV types 16, 20, 21, 36, alb-2, and AJ001060 were detected in vulvar skin affected by lichen sclerosus. Vulvar squamous papillomatosis harbored HPV types 28 and alb-10. HPV 16 was physically integrated into the host genome in lichen sclerosus skin and possibly in the melanoma associated with pigmented vulvar squamous papillomatosis. Twenty-two percent (4 of 18) of normal control specimens from skin tumor excisions were found to harbor HPV dna (HPV types 3, 54, and alb-7); none of these control samples harbored multiple HPV dna. These findings of multiple HPV dna and integrated HPV 16 in skin associated with vulvar malignant melanoma indicate that HPV may play a role in the development of vulvar malignant melanoma. The role of HPV could be either direct through infection of melanocytes or indirect as a cofactor with free radicals in chronic fibroinflammatory vulvar disorders such as lichen sclerosus.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/37. Colonoscopic detection of a malignant melanoma metastatic to a tubular adenoma of the colon: report of a case.PURPOSE: Metastasis of a malignant neoplasm to a benign tumor is an infrequent event. adenomatous polyps of the colon have only been reported on three occasions acting as host tumors. We report the first case where a malignant melanoma metastasizing to a tubular adenoma in the colon was detected during colonoscopy. methods: An 85-year-old male with dementia and right hemiparesis presented to the hospital with change of bowel habits, signs and symptoms of anal incontinence, and a perianal ulcer. On physical examination, multiple subcutaneous nodules over his chest and abdominal wall were detected, and laboratory data revealed iron deficiency anemia. A colonoscopy was performed. RESULTS: During colonoscopy, a pedunculated, greenish-brown-colored polyp measuring 2 cm in greatest dimension located in the transverse colon was identified and snared. pathology of this polyp was consistent with a malignant melanoma infiltrating into a tubular adenoma. Subsequently, one of the subcutaneous lesions was biopsied and this revealed malignant melanoma cells metastatic in soft tissue. The primary site of the malignant melanoma could not be identified. CONCLUSION: Polyp-cancer sequence is well documented in colorectal cancer. The vast majority of malignant lesions found in adenomatous polyps in the colon are the consequences of malignant transformation from benign neoplastic colonic adenomatous tissue. The possibility that colonic adenomatous polyps could harbor metastatic tumors should also be entertained. This could change the treatment and may require an appropriate workup.- - - - - - - - - - ranking = 17.284018124202keywords = physical examination, physical (Clic here for more details about this article) |
7/37. Melanotic neuroectodermal tumour of infancy involving the orbit and maxilla: surgical management and follow-up strategy.Melanotic neuroectodermal tumour (MNET) of infancy is a rare benign but locally aggressive tumour. We describe our surgical treatment of MNET of the orbital region. There was osteogenic relapse involving the bone of the orbit, 20 days after macroscopically complete excision of the primary tumour when the patient was 12 weeks old. This is only the second report of osteogenic relapse in MNET. The relapse was treated by excision of the involved orbital floor, preserving the orbital periosteum. The tumour has not recurred in 23 months of follow-up. Residual tumour islets may regress spontaneously after incomplete excision of MNET, but the relapse rate is between 15% and 45%. In our opinion, excising a safety margin of a few mm of apparently healthy bone reduces the risk of relapse. In contrast, the orbital contents should be preserved if they are macroscopically normal. Follow-up consisted of frequent physical examinations and CT scans.- - - - - - - - - - ranking = 17.284018124202keywords = physical examination, physical (Clic here for more details about this article) |
8/37. Bullous malignant melanoma: an unusual differential diagnosis of a hemorrhagic friction blister.BACKGROUND: A 66-year-old woman presented to our outpatient clinic with a 3 x 2.5-cm tense, hemorrhagic-appearing bulla on her forefoot. Histopathology and immunohistochemistry confirmed a transtumoral-transepidermal blister formation within an advanced acrolentiginous malignant melanoma (MM). OBJECTIVE: To study bullous malignant melanoma. methods: Blistering in MMs represents a rare but clinically important pitfall in clinical differential diagnosis. The blisters are typically due to the disruption of the cohesion between neoplastic cells and keratinocytes, but physical friction may also contribute. RESULTS: Hemorrhagic blistering is, in many cases, a relatively insignificant finding in which frictional forces are imposed. CONCLUSION: The case reported here underscores that in rare cases MMs, particularly if acrally located, can be complicated by hemorrhagic blistering. Because of the life-threatening consequences, one should be aware of this rare differential diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/37. Spontaneous regression of subcutaneous metastasis of cutaneous melanoma.A case is presented of a 44-year-old Caucasian man who was operated on in October of 1988 for a cutaneous melanoma in his trunk and who in the space of 1 year manifested a single subcutaneous nodule compatible with a metastasis of melanoma by fine-needle aspiration biopsy. No other abnormal findings were revealed by physical and instrumental examinations. During the subsequent hospitalization, we witnessed (in conjunction with the occurrence of painful symptoms in the hands of an inflammatory nature) the total, progressive, spontaneous regression of the metastasis, which was confirmed by the clinic and the tests. After 15 months of follow-up, the patient has not shown any further signs of illness.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/37. Pigmented bowen's disease mimicking cutaneous melanoma: clinical and dermoscopic aspects.BACKGROUND: Pigmented bowen's disease (BD) (squamous cell carcinoma in situ) has been rarely described among white patients. OBJECTIVE AND methods: We report the case of a 48-year-old white male presenting a lesion of pigmented BD on his left thigh, clinically mimicking a superficial spreading melanoma. RESULTS: Naked-eye physical examination revealed a single 1.8 x 1.5 cm, hyperpigmented plaque with a rough surface, which appeared irregularly shaped and sharply demarcated. The assessment of this uncommon tumor by means of dermoscopy, never reported in literature before, was performed. According to standardized terminology, none among the well-established dermoscopic criteria useful to discriminate between melanocytic and nonmelanocytic origin was detected within the lesion. A reticular pigmentation simulated remnants of atypical pigment network, being of uncertain diagnostic value in the preoperative classification of the lesion. Other recognized patterns were irregular, brown globular structures and wide regression-like areas. None of the features diagnostic for pigmented basal cell carcinoma was found as well. CONCLUSION: The correct classification of nonmelanocytic origin of the lesion was therefore achieved only at histologic examination, after the complete surgical excision. In spite of its rarity, pigmented BD should be included among those lesions, which may simulate cutaneous melanoma. According to criteria validated by literature, dermoscopy failed to improve a preoperative classification of this peculiar skin tumor.- - - - - - - - - - ranking = 17.284018124202keywords = physical examination, physical (Clic here for more details about this article) |
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