Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 7, Num. 1, 2011, pp. 96-97

Journal of Cancer Research and Therapeutics, Vol. 7, No. 1, January-March, 2011, pp. 96-97

Letter to the Editor

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

Sandip Basu¹, Nirmala A Jambhekar²

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

Correspondence Address: Sandip Basu, Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai 400 012, Maharashtra, India, drsanb@yahoo.com

Code Number: cr11023

PMID: 21546755

DOI: 10.4103/0973-1482.80451

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.

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

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