Metastatic multifocal melanoma of multiple organ systems: A case report

Figure 1 Computed tomography scan. A: Lesions in the liver, spleen, subcutaneous tissue (arrows); B: Lesions in the lungs (arrow); C: Pathological lymphadenopathy of the neck (arrow).

Figure 2 Upper endoscopy. A: Atypical ulcers of the duodenum; B: Atypical polyps in gastric fundus (arrow); C: Atypical polyp in descending part of the duodenum.

Figure 3 Stomach lesion and duodenal biopsy. A: Stomach lesion biopsy. Ulcerated diffuse infiltrate in body-type mucosa; B: Duodenal biopsy. Subtle focal infiltrate in lamina propria, composed of medium-sized dyscohesive cells.

Figure 4 Immunohistochemistry. Tumor cells diffusely and intensely positive for microphthalmia-associated transcription factor, diffusely positive for CD99, partially positive for S100 and focally faintly positive for HMB45 and Melan-A. Ki-67 proliferation index was up to 80%. MiTF: Microphthalmia-associated transcription factor.

Figure 5 Bone marrow trephine biopsy. A: Metastatic melanoma with focal necrosis replacing hematopoietic tissue; B: Diffuse compact infiltrate of epithelioid cells with clear or pale cytoplasm and oval, indented or elongated nuclei.

Figure 6 Strong diffuse tumor positivity for BRAF. A: Gastric biopsy, B: Bone marrow trephine biopsy.

Figure 7 Case history timeline. CT: Computed tomography.