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Metastatic Melanoma: An Unusual Diagnosis for a Large Anterior Mediastinal Mass¹

¹ From the Departments of Radiology (B.L., M.C.S.) and Pathology (R.G.), Beth Israel Medical Center, 1st Ave at 16th St, New York, NY 10003. Received December 15, 2003; revision requested January 20, 2004, and received March 1; accepted March 8. All authors have no financial relationships to disclose. Address correspondence to B.L. (e-mail: barbloew@hotmail.com).

View larger version (118K): [in a new window]   Figure 1a.  Posteroanterior (a) and lateral (b) chest radiographs obtained in June 2003 show a large mass in the right anterior mediastinum and a right subpulmonic pleural effusion.

View larger version (136K): [in a new window]   Figure 1b.  Posteroanterior (a) and lateral (b) chest radiographs obtained in June 2003 show a large mass in the right anterior mediastinum and a right subpulmonic pleural effusion.

View larger version (128K): [in a new window]   Figure 2a.  (a) Contrast-enhanced CT scan shows the large, heterogeneous, low-attenuation mass in the anterior mediastinum and a low-attenuation mass in the left atrium. The small right pleural effusion is also seen. (b) CT scan (lung window) shows a small nodule at the right lung base that abuts the pleural surface.

View larger version (126K): [in a new window]   Figure 2b.  (a) Contrast-enhanced CT scan shows the large, heterogeneous, low-attenuation mass in the anterior mediastinum and a low-attenuation mass in the left atrium. The small right pleural effusion is also seen. (b) CT scan (lung window) shows a small nodule at the right lung base that abuts the pleural surface.

View larger version (130K): [in a new window]   Figure 3.  Axial fat-saturated double inversion-recovery MR image shows the large mass of the right upper lobe and anterior mediastinum abutting the anterior chest wall. The left atrial mass is also seen and demonstrates similar signal intensity characteristics.

View larger version (206K): [in a new window]   Figure 4.  Malignant melanoma metastatic to the lung. High-power photomicrograph (original magnification, x20) of the mediastinal mass shows large pleomorphic cells with prominent nucleoli. Some of the cells contain melanin.

View larger version (155K): [in a new window]   Figure 5a.  External (a) and cross-sectional (b) photographs of the gross specimen show the brown-tan, lobulated mediastinal mass.

View larger version (87K): [in a new window]   Figure 5b.  External (a) and cross-sectional (b) photographs of the gross specimen show the brown-tan, lobulated mediastinal mass.

View larger version (182K): [in a new window]   Figure 6.  Cardiac myxoma. High-power photomicrograph (original magnification, x40) shows a prominent acid mucopolysaccharide background with interspersed round, plump, and stellate cells, some in a cordlike arrangement.

View larger version (153K): [in a new window]   Figure 7.  Malignant melanoma metastatic to the lung. Photomicrograph (original magnification, x2) shows the poorly circumscribed hyperchromatic mass extending to the visceral pleura.