case_images: PMC3804821_01
case_images: A) Nests of cells with abundant eosinophilic to clear cytoplasm and marked nuclear pleomorphism. Note atypical mitotic figure (arrow) [Hematoxylin and eosin, x500]; B) multinucleated tumor cells (arrows) [Hematoxylin and eosin, x500]; C) geographic necrosis (right) [Hematoxylin and eosin, x250]; D) positive immunoreactivity for Melan-A [x500].
case_images: rt-2013-3-e46-g001.jpg
case_images: PMC3804821_01_rt-2013-3-e46-g001.jpg
case_images: fig001
case_images: Immunophenotyping of the original and metastatic tumors was characteristic of EAML, with positive staining for at least one melanocytic marker (Figure 1A-D).
case_images: PMC3804821_02
case_images: Computed tomography scan of abdomen and pelvis showing diffuse metastases involving the liver (B), pancreas (B) as well as a cardiophrenic mass (A) and right ovarian mass (C).
case_images: rt-2013-3-e46-g002.jpg
case_images: PMC3804821_02_rt-2013-3-e46-g002.jpg
case_images: fig002
case_images: Repeat imaging on readmission revealed new hypodensities throughout the liver and lungs; new masses in the pancreas and uterus; enlargement of the right cardiophrenic mass; near-complete occlusion of the portal vein, IVC, and SMV; and a focal hypodensity in the right atrium suggestive of extension of a SVC thrombus (Figure 2), despite being on Warfarin with documented therapeutic INRs.
case_images: PMC3804821_03