case_images: PMC11043509_01
case_images: (A) Histopathology of the scalp tumor resection specimen showing a malignant melanoma. (B) Histopathology of the cervical lymph node resection specimen showing a malignant melanoma. (C) Histopathology of the cervical resection specimen, showing squamous cell carcinoma.
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case_images: The postoperative pathology report ( Figure 1A ) clearly demonstrated cutaneous melanoma (approximately 2.4 cm x 2 cm) with Breslow thickness (1.1 cm) and ulceration (0.1 cm) from the closest point of the basal cut edge. Postoperative pathological examination showed metastatic melanoma in the left cervical lymph node ( Figure 1B ) and stage Ib cervical squamous cell carcinoma (7 cm x 5.5 cm x 3 cm) without lymph node metastasis ( Figure 1C ).
case_images: Whole spinal cord MRI showing multiple foci of striated enhancement of the spinal nerves, assessing metastasis in the soft spine (arrows are foci of spinal nerve enhancement).
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case_images: The patient developed bilateral lower limb weakness, and whole spinal cord MRI showed leptomeningeal disease in March 2023 ( Figure 2 ).
case_images: Lumbar spine MRI showing multiple cord shadows at the cauda equina, which were significantly thickened and increased, indicating the rapid progression of the disease. (A) Sagittal T1 sequence; (B) Sagittal T2 sequence; (C) Coronal enhancement sequence; (D) Transverse enhancement sequence (arrows indicate tumor foci).
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case_images: Cranial MRI was used to assess disease progression ( Figure 3 ).
case_images: Albumin and glucose concentrations in CSF after IT pembrolizumab therapy.
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case_images: Albumin and glucose levels in the CSF decreased ( Figure 4 ).
case_images: Clinical timeline.
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case_images: The patient subsequently experienced disease progression with intermittent respiratory and cardiac arrest and died 2 weeks after the second IT pembrolizumab infusion from unrecoverable respiratory arrest ( Figure 5 ).