Hematoma-like metastases

Acute Headache Due to Intracerebral Hemorrhage Secondary to Brain Metastases

Intracerebral hemorrhage (ICH) is a relatively common condition seen throughout the world, with the vast majority of cases referring to primary ICH. However, secondary ICH from other underlying conditions is also possible. In the present case, the patient presented with severe headaches. An initial computed tomography (CT) was taken which showed hyperdense regions in both the occipital lobe and right lateral ventricle. The patient was hypertensive upon arrival, so medication was given to lower his blood pressure. Due to the patient's history of hypertension, it was believed to be a case of primary ICH caused by high blood pressure, but because of the odd positioning of the hemorrhaging, it was recommended for magnetic resonance imaging (MRI) and angiography (MRA) to be taken. Using the MRI and MRA, it was found out that growing nodes were responsible for the hypodense regions on the CT. Considering the patient's history of renal cell carcinoma metastasizing to the abdomen and lungs, the nodes were diagnosed as brain metastasis (BM) developed from the patient's past kidney cancer. Considering the hemorrhaging locations in the brain, it was concluded that the ICH was secondary to BM. After consulting neurosurgery and hematology, the patient was discharged to his family. Although not very prevalent in cases of ICH, BM is a cause that can not be overlooked. Sometimes initial imaging does not reveal such an underlying source. It is always important to pay close attention to the characteristics of the ICH so that it is possible to determine the true reason for the hemorrhage.

Sentinel bruising as a presentation of metastatic melanoma

A 46-year-old man presented with a 4-week history of bruising with subcutaneous nodules and weight loss. He also had a 2-week history of progressive back and hip pain. He had been diagnosed with stage Ib cutaneous melanoma 30 months previously, which had been fully excised. A sentinel lymph node biopsy was negative. On examination, there were five skin lesions at different stages. Each had spontaneously appeared as a bruise with a central subcutaneous nodule, and the bruising then faded to leave a persistent subcutaneous nodule. Excision of one of the nodules demonstrated a 4.5 mm diameter partly necrotic melanoma deposit in the dermis. CT scan of the head, chest, abdomen and pelvis showed widespread metastases. This rare presentation of cutaneous malignant melanoma metastases has been termed 'sentinel bruising'. There are fewer than 10 cases reported in the literature.

Resolution of Cullen's sign in patient with metastatic melanoma responding to hypoxia-activated prodrug TH-302

Cullen's sign, ecchymosis of the subcutaneous periumbilical tissue often described in association with non-malignant conditions such as ruptured ectopic pregnancy or acute pancreatitis, has been reported in malignancies involving the abdomen. In melanoma, hematoma-like metastasis has been observed and can resolve with an effective therapy. We observed resolution of Cullen's sign (probably hematoma-like metastasis) in a patient with metastatic melanoma. The patient was participating in a phase I clinical trial and treated with TH-302, a hypoxia-activated prodrug. After 2 months on study, complete resolution of Cullen's sign resolved in concert with extracranial response in lung, liver, and lymph node metastases. Based on the dramatic extracranial response to this investigational agent, additional patients with metastatic melanoma without evidence of brain metastasis were treated on study with TH-302.

[Metastatic cutaneous hematoma variant from melanoma: five cases]

INTRODUCTION

Melanoma is an aggressive tumor with high metastatic potential. We described herein five patients with metastatic cutaneous hematoma variant from melanoma.

OBSERVATIONS

Patients were four men and one woman, four were already known for melanoma. In one case, the occurrence of hematoma leads to the diagnosis of metastatic melanoma. These hematomas were true hematomas, which had appeared spontaneously and in some cases a nodule or lymphadenopathy was clinically found. A biopsy was performed in two cases, showing the sub-cutaneous metastasis with hemorrhages (histological hematoma) and vascular proliferation within tumor cells. Patients were not treated by anti-coagulants or antiagregants and biological tests were not exhibiting any coagulation trouble. Evolution was rapidly dramatic with generalized metastatic disease and death.

DISCUSSION

Metastatic cutaneous hematoma is a particular type of cutaneous metastasis, poorly reported in the literature. This phenomenon could be explained by local tumoral neoangiogenesis and hematogenous metastatic spread.

CONCLUSION

We report five cases of metastatic cutaneous hematomas of melanoma. This clinical presentation doesn't seem to be so rare. This clinical variant should be known from oncologists in order to perform a biopsy looking for a metastatic cutaneous involvement from melanoma.

Stroke and cancer: a review

Stroke is a disabling disease and can add to the burden of patients already suffering from cancer. Several major mechanisms of stroke exist in cancer patients, which can be directly tumour related, because of coagulation disorders, infections, and therapy related. Stroke can also occur as the first sign of cancer, or lead to its detection. The classical literature suggests that stroke occurs more frequently in cancer patients than in the average population. More recent studies report a very similar incidence between cancer and non-cancer patients. However, there are several cancer-specific types and causes of stroke in cancer patients, which need to be considered in each patient. This review classifies stroke into ischaemic, haemorrhagic, cerebral venous thrombosis and other rarer types of cerebrovascular disease. Its aim is to identify the types of stroke most frequently associated with cancer, and give a practical view on the most common and most specific types of stroke. The diagnosis of the cause of stroke in cancer patients is crucial for treatment and prevention. Management of different stroke types will be briefly discussed.