Magnetic resonance imaging of nasopharyngeal and paranasal sinus melanoma

Hammersmith, Scott M.; Terk, Michael R.; Jeffrey, P. B.; Connolly, Stephen G.; Colletti, Patrick M.

doi:10.1016/0730-725x(90)90096-k

Cited by 18 publications

(9 citation statements)

References 14 publications

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“…The higher the melanin content of the tumor, the more intense is the signal intensity on T1-weighted and the lower is the signal intensity on T2-weighted images. [7][8][9][10][11][12] As stated previously, our 2 patients showed similar MR imaging appearances, which indicated melanotic melanoma. Conversely, amelanotic melanoma will generally demonstrate hypointensity on T1-weighted and hyperintensity on T2-weighted images and thus is not easy to diagnose on the basis of the MR imaging alone.…”

Section: Discussionsupporting

confidence: 48%

MR Imaging Features of Primary Mucosal Melanoma of the Eustachian Tube: Report of 2 Cases

Yang¹,

Wang²,

Jian³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We observed 2 cases of malignant melanoma arising from the eustachian tube with MR imaging. In this region, we explored further characteristics of primary mucosal melanoma. We discuss the value of using MR imaging to diagnose and treat patients with melanoma in the eustachian tube. In addition, we introduce the key points to differentiate melanoma from some common diseases in the region. Malignant melanoma primarily affects the skin, rarely the mucosa. Melanoma of the upper airway mucosa constitutes approximately 1% of the total melanoma of the head and neck.1 Primary melanoma of the eustachian tube is even rarer. In a series of 158 cases of mucosal melanoma of the upper airway, only 2 cases were located at the eustachian tube orifice in the nasopharynx.2 To the best of our knowledge, only 6 cases of primary melanoma of the eustachian tube have been reported in the literature to date [2][3][4][5] ; unfortunately, the corresponding MR imaging findings were not described effectively. During the past 5 years, melanoma of the eustachian tube in the nasopharynx has been positively proved through histopathology in 2 patients at our hospital. These 2 patients underwent MR imaging. Case Reports Case 1A 75-year-old man with mild hypertension and an intermittent epistaxis for the past 20 days was examined. An otorhinolaryngologic examination showed serous otitis media of the left ear and a brownblack soft-tissue mass with surface irregularity in the left nasopharynx. The pharyngeal orifice of the left eustachian tube was obstructed. MR imaging revealed an elliptic well-defined 1.2 ϫ 2.0 ϫ 1.4 cm mass in the left nasopharynx, arising from the left eustachian tube. The lesion showed signal intensity hyperintense to gray matter on T1-weighted images and hypointense signal intensity on T2-weighted images with moderate homogeneous contrast enhancement following the administration of contrast material (Fig 1A-C). The timeintensity curve of dynamic contrast-enhanced (DCE) MR imaging was a rapidly enhancing and rapid washout type (Fig 1D, -E). The lesion was complicated with serous otitis media of the left ear, which showed hypointense signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images without significant contrast enhancement. Neither an enlarged retropharyngeal node, evidence of head and neck melanoma, nor systemic abnormalities were observed. A surgical specimen of the brown-black mass in the left eustachian tube was histopathologically proved to be malignant melanoma. On immunohistochemistry, tumor cells were strongly positive for S-100, vimentin, and melanoma antibody HMB45. Case 2A 35-year-old woman with no significant medical history presented with a 2-year history of hearing decrease and with a 1-month intermittent epistaxis. An otorhinolaryngologic examination revealed serous otitis media of the left ear and an irregular coarse friable grayblack soft-tissue mass occupying the whole pharyngeal orifice of the left eustachian tube in the nasopharynx. MR imaging showed an el...

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Section: Discussionsupporting

confidence: 48%

MR Imaging Features of Primary Mucosal Melanoma of the Eustachian Tube: Report of 2 Cases

Yang¹,

Wang²,

Jian³

et al. 2008

AJNR Am J Neuroradiol

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“…In contrast, Hammersmith et al (6), in a study of five cases of nasopharyngeal and paranasal sinus melanoma, found that the dominant portions of four of the tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. Extremely variable amounts of paramagnetic substances were present, including both melanin and products of hemorrhage.…”

Section: Nasopharynx and Mucosamentioning

confidence: 94%

“…On the basis of the results of these studies, there is no clear consensus as to whether the appearance of melanoma is due primarily to the paramagnetic effects of blood products or of melanin, and it is likely due to variable contributions from both (1)(2)(3)6). …”

Section: Other Patternsmentioning

confidence: 95%

“…Arriaga et al (5), in a study of four lesions in the cerebellopontine angles and internal auditory canals in three patients, found that the lesions did not have the typical signal intensity of melanoma but were isointense on T1-weighted images and hyperintense on T2-weighted images. Hammersmith et al (6), in a study of five cases of nasopharyngeal and paranasal sinus melanoma, found that there were extremely variable amounts of paramagnetic substances in the lesions, including both melanin and products of hemorrhage. The dominant portions of four of the tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images.…”

Section: Other Patternsmentioning

confidence: 99%

“…Malignant melanomas of the nasopharynx or nasal cavity are uncommon, making up no more than 0.6%-0.9% of all melanomas (6). In a review of 1,546 cases of melanoma that occurred between 1930 and 1948, Moore and Martin (27) analyzed 26 cases of primary melanoma of the mucous membranes of the oral cavity or upper respiratory tract, which accounted for only 1.7% of all cases.…”

Section: Nasopharynx and Mucosamentioning

confidence: 99%

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A Variety of Appearances of Malignant Melanoma in the Head: A Review

Escott¹

2001

RadioGraphics

108

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Metastatic melanoma: Correlation of MRI characteristics and histopathology

Premkumar

Marincola

Taubenberger

et al. 1996

Magnetic Resonance Imaging

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To correlate the findings on MRI with histopathology of metastatic melanoma, MRI was performed on 29 patients with 36 lesions, using spin-echo and inversion recovery sequences. Histopathologic examination of lesions was performed within 4 weeks of imaging. Lesions were categorized according to cell type and were also evaluated for the presence and extent of melanin, iron, and necrosis. These data were then correlated with the signal intensities of the lesions. Enhancement of lesions after injection of intravenous gadolinium was calculated and correlated to vascularity of the tumor. Melanin was present more frequently in lesions appearing hyperintense or with mixed signal intensity (12/15) than in those appearing hypo- or isointense (6/21) on the T1-weighted sequence. This trend was significant (P = .013). Also, more lesions appearing mixed, ie, having both hypo- and hyperintense components, contained melanin (15/23), as opposed to lesions that appeared to be only hyperintense (3/13) on the STIR sequence. There was no clear association between signal intensity and melanin content on the T2-weighted sequence. There was no significant association between the signal intensities on the MR images and the iron content, tumor size, or tumor cell type of these lesions. There was no clear association between enhancement after gadolinium injection and vascularity, as assessed by histology. The authors concluded in this study that T1 shortening and hypointensity on the STIR sequence seen in patients with metastatic melanoma are most closely related to the melanin content of the tumor.

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Magnetic resonance imaging of nasopharyngeal and paranasal sinus melanoma

Cited by 18 publications

References 14 publications

MR Imaging Features of Primary Mucosal Melanoma of the Eustachian Tube: Report of 2 Cases

MR Imaging Features of Primary Mucosal Melanoma of the Eustachian Tube: Report of 2 Cases

A Variety of Appearances of Malignant Melanoma in the Head: A Review

Metastatic melanoma: Correlation of MRI characteristics and histopathology

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