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Cardiac Metastases from Melanoma¹

¹ From the Departments of Medical Imaging (M.T., C.L.), Pathology (L.O.), Cardiology (J.L.B.), and Hematooncology (M.C.), Hôpital Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine Rd, Montreal, Quebec H3T 1C5, Canada. Received March 30, 2004; revision requested April 27 and received May 27; accepted June 1. All authors have no financial relationships to disclose. Address correspondence to C.L. (e-mail: chantal_lapierre@ssss.gouv.qc.ca).

View larger version (116K): [in a new window]   Figure 1.  US image (apical four-chamber view) shows an irregular mass (arrowhead) within the middle to apical portion of the left ventricle. Mild to moderate pericardial effusion is noted lateral to the left ventricle.

View larger version (107K): [in a new window]   Figure 2a.  Axial unenhanced T1-weighted (a), fat-saturated T2-weighted (b), and contrast-enhanced T1-weighted (c) MR images show an intramyocardial mass (short straight arrow) arising from the apex of the left ventricle. The free wall of the left ventricle and a portion of the interventricular septum have an irregular, heterogeneous appearance. Pleural (long straight arrow) and pericardial (curved arrow) effusions and numerous subcutaneous lesions of the chest wall (arrowheads) are also seen. Note the intense enhancement of the mass, free wall of the left ventricle, interventricular septum, and chest wall lesions in c.

View larger version (107K): [in a new window]   Figure 2b.  Axial unenhanced T1-weighted (a), fat-saturated T2-weighted (b), and contrast-enhanced T1-weighted (c) MR images show an intramyocardial mass (short straight arrow) arising from the apex of the left ventricle. The free wall of the left ventricle and a portion of the interventricular septum have an irregular, heterogeneous appearance. Pleural (long straight arrow) and pericardial (curved arrow) effusions and numerous subcutaneous lesions of the chest wall (arrowheads) are also seen. Note the intense enhancement of the mass, free wall of the left ventricle, interventricular septum, and chest wall lesions in c.

View larger version (114K): [in a new window]   Figure 2c.  Axial unenhanced T1-weighted (a), fat-saturated T2-weighted (b), and contrast-enhanced T1-weighted (c) MR images show an intramyocardial mass (short straight arrow) arising from the apex of the left ventricle. The free wall of the left ventricle and a portion of the interventricular septum have an irregular, heterogeneous appearance. Pleural (long straight arrow) and pericardial (curved arrow) effusions and numerous subcutaneous lesions of the chest wall (arrowheads) are also seen. Note the intense enhancement of the mass, free wall of the left ventricle, interventricular septum, and chest wall lesions in c.

View larger version (142K): [in a new window]   Figure 3.  Photograph of the gross specimen demonstrates portions of the right atrium (top) and right ventricular septum, both of which are studded with subendocardial tumorlets, some of which are polypoid. The tumorlets range from tan to dark brown and black. Intramyocardial tumor nodules are also seen, but the tricuspid valve (arrow) is tumor free.

View larger version (178K): [in a new window]   Figure 4.  Low-power photomicrograph (original magnification, x25; hematoxylin-phloxin-saffron [HPS] stain) of the left ventricle shows two large, exophytic, extensively necrotic subendocardial metastases (long arrows) obstructing the ventricular cavity (*). In addition, three smaller metastases are seen within the myocardium (short arrows).

View larger version (201K): [in a new window]   Figure 5.  High-power photomicrograph (original magnification, x400; HPS stain) shows a metastatic nodule (arrow) with moderate nuclear pleomorphism, coarse chromatin, and, in some cells, a prominent acidophilic nucleolus. Most cells contain a large amount of cytoplasm, which is finely granular, acidophilic, and, occasionally, vacuolated. Numerous focal mitoses (not shown) were also seen.