A Case of Bone Marrow Metastatic Malignant Melanoma Presenting Microangiopathic Hemolytic Anemia As Initial Clinical Findings

The incidence and mortality rate of malignant melanoma has been increasing steadily over the past decade. The most common occurrence of marrow metastases in nonhematologic malignancies is in patients with carcinomas arising in the prostate, breast, lung and neuroblastoma but extremely rare in malignant melanoma. We report a rare case with presentation of simultaneous bone marrow metastatic malignant melanoma, microangiopathic hemolytic anemia and inguinal lymphadenopathy. A 59 years old female was admitted to hospital due to febrile and chilling sense for one month. On past history, a superficial skin lesion had been resected one year ago from the skin on right sole. On admission she had a 3 H 3cm sized well circumscribed right inguinal lymph node without any other lymphadenopathy. The hemogram revealed a hemoglobin of 9.6g/dL, leukocyte count of 22.8H 109/L, and platelet count of 95× 109/L. Studies for evaluation of primary cancer origin including chest, abdomen CT scanning, upper gastrointestinal series, colon barium enema, and radionuclide bone scan were normal except metastatic pulmonary nodule. Peripheral blood smear showed microspherocytes, fragmented RBCs, nucleated RBCs and myelocytes. Bone marrow aspiration and biopsy showed diffuse infiltration of marrow space by spindle shaped dysplastic cells having brown cytoplasmic pigment. These cells were stained positively for S 100 protein and HMB45 monoclonal antibody, negative for cytokeratin and desmin.ope