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. 2021 Jun 24;92(6):753–759. doi: 10.1080/17453674.2021.1941624

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© 2021 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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graphic file with name IORT_A_1941624_F0005a_B.jpg — Case no. 9. A 74-year-old male with lymph node melanoma metastasis and synchronous cat scratch disease. (A) Enlarged axillary lymph nodes with heterogenous contrast enhancement on coronal postcontrast T1-weighted image with fat saturation; no signs of necrosis (star). (B) Sonography shows irregular 28 x 26 mm large lymph nodes with the heterogeneous structure without necrosis and hyperechogenic surrounding subcutaneous tissue (arrow). (C) On axial short tau inversion recovery (STIR) image and (D) T1-weighted image pathologically changed lymph nodes with a heterogenous signal. Centrally, on T2-weighted image low signal intensity with hyperintense signal intensity on T1-weighted image corresponds to melanin (arrows). (E) Histologically shows granuloma with central necrosis (star) and malignant melanoma metastasis (arrow). (F) Higher-power view of the granuloma with extensive central necrosis, surrounded by palisading histiocytes and (G) atypical melanocytes. (H) Malignant melanoma is immunohistochemically positive with SOX10 (Inlet: positive reaction to Melan A).

graphic file with name IORT_A_1941624_F0005b_C.jpg — Case no. 9. A 74-year-old male with lymph node melanoma metastasis and synchronous cat scratch disease. (A) Enlarged axillary lymph nodes with heterogenous contrast enhancement on coronal postcontrast T1-weighted image with fat saturation; no signs of necrosis (star). (B) Sonography shows irregular 28 x 26 mm large lymph nodes with the heterogeneous structure without necrosis and hyperechogenic surrounding subcutaneous tissue (arrow). (C) On axial short tau inversion recovery (STIR) image and (D) T1-weighted image pathologically changed lymph nodes with a heterogenous signal. Centrally, on T2-weighted image low signal intensity with hyperintense signal intensity on T1-weighted image corresponds to melanin (arrows). (E) Histologically shows granuloma with central necrosis (star) and malignant melanoma metastasis (arrow). (F) Higher-power view of the granuloma with extensive central necrosis, surrounded by palisading histiocytes and (G) atypical melanocytes. (H) Malignant melanoma is immunohistochemically positive with SOX10 (Inlet: positive reaction to Melan A).