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FIG 1. Images from the case of a 24-year-old man with primary leptomeningeal melanoma.
A, Photomicrograph (hematoxylin and eosin stain; original magnification, x200) from the corticomeningeal biopsy shows the atypical cells with melanin granules. Tumor cells diffusely invaded along the pia mater and spread into the subarachnoid space, indicating a leptomeningeal melanoma.
B, SPECT scan of the brain, obtained during the terminal state, shows increased uptake of Tc-99m-HMPAO in the basal cistern and cisterns surrounding the brain stem, both cerebellar hemispheres, and both sylvian fissures.
C, SPECT scan of the brain shows severe hypoperfusion in the cerebral and cerebellar hemispheres, especially in the brain stem, both cerebellar hemispheres, and thalami.
D and E, Contrast-enhanced T1-weighted MR images (600/16/1 [TR/TE/NEX]), obtained during the terminal state, show thick and diffuse leptomeningeal enhancement in the whole leptomenigeal and subarachnoid space.
F, Macroscopic appearance at the base of the brain. The brain is thickly and diffusely covered with black tumors, indicating the primary leptomeningeal melanoma.
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