Diagnostic Pathway From Incidental Mass to Metastatic Melanoma

Figures

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  Figure 1. Echocardiography, CT, and CMR Images (A) Echocardiography shows right atrial mass (blue arrow), attached to the fossa ovalis. (B) Computed tomography transverse view shows infiltration of the pericardium (blue arrow), compatible with cardiac sarcoma or metastatic disease. (C) Computed tomography sagittal view show infiltration of pericardial tissue (blue arrow). (D) Cardiac magnetic resonance cine image transverse view shows myocardial infiltration (central blue arrow). (E) Cardiac magnetic resonance first-pass perfusion short-axis view shows reduced perfusion (blue arrow) of the tumor compared to myocardium. (F) Late gadolinium enhancement shows inhomogeneous enhancement (blue arrows). (G) T1 mapping shows hyperintense appearance (blue arrow). (H) Inversion recovery image T2-weigthed image shows hyperintense tumor (blue arrow).

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  Figure 2. Histopathological Images and Immunohistochemistry Staining (A) Hematoxylin and eosin staining of the liver biopsy shows normal liver parenchyma (left side, ∗) and tumor tissue (right side, ∗∗). (B) Hematoxylin and eosin staining at higher digital magnification shows tumor tissue. (C) SOX10 immunohistochemistry staining allows us to establish a diagnosis of amelanotic melanoma.

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  Figure 3. Diagnostic Flow Chart CCT = cardiac computed tomography; CMR = cardiac magnetic resonance; LGE = late gadolinium enhancement.

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  Figure 4. Follow-Up Echocardiography Follow-up echocardiography of the patient at 3 months demonstrating tumor regression (after 3 immunotherapy cycles): (A) 4-chamber view; (B) subcostal view. Follow-up echocardiography after 6 months demonstrating slight regression; (C) 4-chamber view. The blue arrows indicate the metastatic melanoma in all three panels.