Elsevier

American Journal of Otolaryngology

Volume 21, Issue 6, November–December 2000, Pages 366-378
American Journal of Otolaryngology

Original Contributions
Malignant melanoma of the sinonasal cavity: Explanation of magnetic resonance signal intensities with histopathologic characteristics,,*

https://doi.org/10.1053/ajot.2000.18865Get rights and content

Abstract

Purpose: To evaluate the magnetic resonance (MR) findings of malignant melanoma of the sinonasal cavity and compare these findings with those of the histopathological examination. Materials and Methods: The MR images of 11 patients with malignant melanoma of the sinonasal cavity were retrospectively reviewed. Ten patients had primary malignant melanoma of the sinonasal cavity and one had a local recurrence. The imaging findings were evaluated with special attention given to the signal intensity of the tumor, internal characteristics, and growth pattern on MR. Signal intensity and enhancement patterns of the tumors were compared with the histopathological findings. Results: On T1-weighted image, 6 tumors were hyperintense (5 melanotic and one amelanotic melanoma), and 5 tumors were isointense or hypointense (4 amelanotic and one melanotic). On T2-weighted images, 2 amelanotic tumors showed hyperintensity, and 5 melanotic tumors showed hypointensity. Four tumors (one melanotic and 3 amelanotic) were isointense. Four of the 7 tumors with hyperintensity on T1-weighted images showed patchy, higher-signal intensity areas. In 3 of them, patchy areas of a higher degree of pigmentation were found on histopathological examination. There were multiple linear dark signal intensities on T2-weighted images and/or linear-enhancing areas on enhanced T1-weighted images within the masses in 5 of the 11 patients. These findings could be explained as intratumoral vessels in 4 tumors and fibrous septa in one tumor on histopathological examinations. Conclusion: Malignant melanoma of the sinonasal cavity shows characteristic MR signal intensity, which is mainly attributable to the degree and distribution of melanin pigmentation, and partly attributable to hemorrhage within the mass. The linear, low-signal intensity on T2-weighted images or enhanced lines are intratumoral vessels or fibrous septa. (Am J Otolaryngol 2000;21:366-378. Copyright © 2000 by W.B. Saunders Company)

Section snippets

Materials and methods

We retrospectively reviewed the MR images of 11 patients who had surgical-resection- (n = 4) or biopsy- (n = 7) proven malignant melanoma of the sinonasal cavity at our hospital between January of 1994 and October of 1998. The series included 5 men and 6 women, aged between 35 to 77 years old, with mean age of 59 years. Ten of 11 patients had primary malignant melanoma of the sinonasal cavity. For these patients, we performed the physical and ophthalmoscopic examination on the skin and eye

Results

The tumors were located in the nasal cavity (n = 5), the maxillary sinus (n = 2), and the ethmoid sinus (n = 1). In 3 patients, the original site of lesions could not be determined because each tumor was extensively involved in multiple anatomic structures. In the patient in case 3, involved sites were right nasal cavity, right ethmoid sinus, right maxillary sinus, right orbit, and soft tissue beyond bony wall of the right maxillary sinus. In the patient in case 5, the right maxillary sinus,

Discussion

Sinonasal melanomas arise from melanocytes that have migrated during embryological development from the neural crest to the mucosa of the nose and sinuses. The most common site of origin is the nasal septum, closely followed by the lateral nasal wall, and then the middle and inferior turbinates. Melanomas of the nasal cavity are 2 or 3 times more common than those of the sinuses. The antrum is the site of origin in 80% of paranasal sinus cases. In addition, disease is too extensive in certain

References (19)

  • SM Hammersmith et al.

    Magnetic resonance imaging of nasopharyngeal and paranasal sinus melanoma

    Magn Reson Imaging

    (1990)
  • HF Marx et al.

    Magnetic resonance imaging features in melanoma

    Magn Reson Imaging

    (1990)
  • BS Slasky et al.

    Computed tomography appearance of melanoma of nasal cavity

    J Comput Tomogr

    (1985)
  • JG Batsakis

    Tumors of the Head and Neck: Clinical and Pathological Considerations

  • ES Moore et al.

    Melanoma of upper respiratory tract and oral cavity

    Cancer

    (1955)
  • C Matias et al.

    Primary malignant melanoma of the nasal cavity: A clinicopathologic study of 9 cases

    J Surg Oncol

    (1988)
  • WW Woodruff et al.

    Intracerebral malignant melanoma: High-field-strength MR imaging

    Radiology

    (1987)
  • I Isiklar et al.

    Intracranial metastatic melanoma: Correlation between MR imaging characteristics and melanin content

    AJR AJR Am J Roentgenol

    (1995)
  • KA Tong et al.

    Radiological-pathologic correlation ocular melanoma

    AJNR Am J Neuroradiol

    (1993)
There are more references available in the full text version of this article.

Cited by (36)

  • Management of Head and Neck Mucosal Melanoma

    2022, Oral and Maxillofacial Surgery Clinics of North America
  • Imaging in Otolaryngology

    2018, Imaging in Otolaryngology
  • Mucosal melanoma of the head and neck

    2017, Critical Reviews in Oncology/Hematology
    Citation Excerpt :

    When the abovementioned pattern is absent, MM is in most cases indistinguishable from other histotypes. Linear signal voids within the lesion, that may represent vessels or fibrous septa, and contrast enhancement, generally heterogeneous, are poorly specific findings (Kim et al., 2000) (Fig. 2). The apparent diffusion coefficient (ADC) measured with diffusion weighted (DWI) sequences is a finite parameter quantifying the mobility of water molecules within tissues.

  • Diagnostic Imaging: Head and Neck

    2017, Diagnostic Imaging: Head and Neck
  • Mucosal melanoma of the nasal cavity and paranasal sinuses

    2014, European Annals of Otorhinolaryngology, Head and Neck Diseases
    Citation Excerpt :

    According to some authors, a spontaneous high-intensity signal on T1 with a low-intensity signal on T2 would be characteristic of melanoma. This unusual appearance, sometimes observed with other types of tumours (angiosarcoma, cylindroma and aesthesioneuroblastoma) appears to be related to the high melanin content and/or bleeding inside the tumour [18,19]. T2-weighted MRI can distinguish tumour invasion from paranasal sinus fluid retention.

View all citing articles on Scopus

Department of Radiology, Seoul National University College of Medicine; the

Department of Pathology, Seoul City Boramae Hospital; and the ‡Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea.

*

Address reprint requests to Moon Hee Han, MD, Department of Diagnostic Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, Seoul 110-744, Korea.

View full text