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IMAGE IN HEMATOLOGY
Year : 2019  |  Volume : 10  |  Issue : 2  |  Page : 73-74

Metastatic malignant melanoma in the bone marrow with occult primary


Department of General Medicine, M.E.S. Medical College Perinthalmanna, Kerala, India

Date of Web Publication10-Jul-2019

Correspondence Address:
Prof. Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College, Perinthalmanna - 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_14_19

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How to cite this article:
Abdulla MC. Metastatic malignant melanoma in the bone marrow with occult primary. J Appl Hematol 2019;10:73-4

How to cite this URL:
Abdulla MC. Metastatic malignant melanoma in the bone marrow with occult primary. J Appl Hematol [serial online] 2019 [cited 2019 Jul 15];10:73-4. Available from: http://www.jahjournal.org/text.asp?2019/10/2/73/262538

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.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed signed written consent was taken from the patient involved.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


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