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Rare case of primary uterine melanoma with brain metastases

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History

A middle-aged female presented with clinical features worrisome for an intracranial mass lesion and was found to have a metastatic lesion in the left temporal lobe.  A PET CT was performed to evaluate for the primary source.  What rare histology of uterine primary can you think of?


Findings

Image 1: A) The non-contrast CT portion of an FDG-PET/CT shows a mass lesion with significant adjacent edema in the left temporal lobe of the brain. B&C) PET and fused PET/CT axial images show increased activity at the periphery of the lesion consistent with a necrotic high-grade lesion. D) MIP PET images show a focus of activity in the midline and in right lower quadrant of abdomen.  No other additional sites of abnormal activity are visualized.

Image 2: Axial PET/CT localizing the increased activity to lower uterine body/upper cervix.

Image 3: Axial PET/CT image showing increased activity in right inguinal lymph node suspicious for metastatic disease.


Diagnosis

Rare case of primary uterine melanoma with brain metastases


Discussion

FDG PET/CT has been shown to be a very useful modality in detecting primary site of tumor in patients with metastatic disease.  Endometrial malignancies are the most common gynecological malignancies in the USA with endometrial carcinoma being the most common histological variant.  Primary melanoma of the uterus and metastases are very rare, but have been reported in literature[1]. 


DDx

1. Endometrial carcinoma 

2. Cervical carcinoma

3. Melanoma of the uterus


References

Myriokefalitaki E, Babbel B, Smith M, Ahmed AS. Primary malignant melanoma of uterine cervix FIGO IIa1: A case report with 40 months ongoing survival and literature review. Gynecol Oncol Case Rep 2013 Apr 23;5:52-54.



Rare case of primary uterine melanoma with brain metastases Image 2

Image 2

Rare case of primary uterine melanoma with brain metastases Image 3

Image 3

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