MyPACS.net: Radiology Teaching Files > Case 1510680

Never visited MELANOMA, RESTAGING
Contributed by: Nuclear Medicine, Radiologist, Stanford University, California, USA.
Patient: 77 year old male
History:

The patient is a 77-year-old male with acral lentiginous melanoma
of the left heel diagnosed in 1997, status post multiple
recurrences and in-transit melanoma. He is presumably at stage
IIIC or IV and is status post lymph node dissections of the left
inguinal region, left femoral region, and left popliteal region.
2004 he had several left lower lobe lesions suspicious for melanoma
that were ablated by laser. Left lower extremity is remarkable for
massive lymphedema.

This case has no images yet.
Findings:


BRAIN: No significant metabolic abnormality is noted on this
limited evaluation.

HEAD AND NECK:
Physiologic activity is appreciated. There is focal minimally
increased activity involving a right submantle cutaneous nodule or
lymph node, transaxial slice 54, SUV 1.1. Correlation is advised.
There is no evidence right or left cervical chain hypermetabolic
lymphadenopathy.

CHEST:
There is bilateral mild hypermetabolic hilar lymphoma, left greater
than right: transaxial slices 91-94 with SUV 2.6 on the right and
transaxial slices 86-87 with SUV 3 on the left. There is a
hypermetabolic prevascular mass: transaxial slices 82-84, SUV 5.6.


Examination of the bilateral lungs is negative for abnormal
increased FDG uptake. Physiologic cardiac activity is appreciated.
There is no evidence of supraclavicular or axillary metabolic
lymphoma.

ABDOMEN/PELVIS:
There is a hypermetabolic pelvic sidewall complex mass which erodes
the adjacent left acetabulum: transaxial slices 174-194, SUV 9.5.
There is focal mildly increased activity involving left abdominal
wall soft tissue, transaxial slice 182, SUV 3.4. There is no
definite CT correlate. Hypermetabolic left inguinal
lymphadenopathy, transaxial slices 184-195, SUV 7.2.

There is focal increased FDG uptake involving a left scrotal mass:
transaxial slices 213-214, SUV 3.4. There is focal increased
activity involving the superficial tissue of the right scrotum,
transaxial slice 215, SUV 2.8. This is the only finding on the
right and may represent physiological inflammatory activity.
Clinical correlation is advised.

LOWER EXTREMITIES:
There are multiple too numerous to count hypermetabolic foci and
soft tissue masses involving the left thigh and left lobe.
Representative transaxial slices are as follows: slice 205 with
SUV 6.2; slice 212, SUV 5.1; slice 216, SUV 2.7; slice 225, SUV
5.6; slice 231, SUV 3.6; slice 237, SUV 3.8 posterior and lateral;
transaxial slice 237-238 with SUV 3.7, deep, no CT correlate. Also
of note is the medial aspect of the distal 1/4 of the left leg.
This region contains the greatest amount of activity that it has
multiple contiguous and confluent foci: representative transaxial
slice 162 on the lower extremity series, SUV 25.9.

The region of the liver, spleen, gastrointestinal tract and urinary
system shows physiologic activity. There is focal increased FDG
uptake involving the right mesenteric soft tissue mass on lymph
node, transaxial slices 129-132, SUV 4.1.


Diagnosis:

IMPRESSION:

1. LARGE COMPLEX HYPERMETABOLIC LEFT PELVIC WALL MASS INVOLVEMENT
OF THE LEFT ACETABULUM MOST CONSISTENT WITH MALIGNANCY.

2. HYPERMETABOLIC FOCI INVOLVING THE FOLLOWING REGIONS ALSO
CONSISTENT WITH INVOLVEMENT BY MELANOMA: POSSIBLY RIGHT SUBMANTLE,
PREVASCULAR, POSSIBLY RIGHT HILAR, LEFT HILAR, RIGHT MESENTERIC,
LEFT ABDOMINAL WALL, LEFT INGUINAL REGION, ENTIRE LEFT LOWER
EXTREMITY.

Comments:
No comments posted.
Additional Details:

Case Number: 1510680Last Updated: 2005-04-26
Anatomy: Other   Pathology: Neoplasm
Modality: CT, PETAccess Level: Readable by all users
Keywords: bone, pelvis, thigh, leg, lower extremity

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.