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RADIOLOGY: ABDOMEN: Case# 32826: METASTATIC MELANOMA AND PROSTATIC CA. A 65 year old white male, follow-up case of metastatic melanoma (diagnosed 5 years ago) and prostate cancer (diagnosed 3 years ago). Patient is status post chemotherapy as well as radiation treatment. Comparison is made with prior abdomen CT done two months ago. Extensive pulmonary nodules of various sizes in both lung fields have increased. Multiple hepatic lesions of varying sizes have also increased in size as well as number with index lesions in the lateral segment of left lobe increased from 2 x 2 cm to 3 x 3.6 cm on todays exam . Multiple splenic lesions have also increased in number as well as the index lesion has increased from 2.9 x 2.2 cm to 3 x 3 cm. Hypodense left adrenal nodule has also increased in size from 1 x 1.2 cm to 1.5 x 1.8 cm . A small hypodense lesion in the head of the pancreas measuring less than 1 cm in size is new. Multiple cystic lesions involving both kidneys are again identified, essentially unchanged including slightly hypodense left mid region cyst. There is no evidence of hydronephrosis. Previously noted small left external iliac as well as left inguinal node are again identified essentially unchanged. Multiple sclerotic bone lesions involving the axial skeleton are again identified and appears to have increased in number. Metastatic melanoma usually shows diffuse involvement of the liver. Lesions may be cystic or necrotic. CT may show hepatomegaly, diffuse liver inhomogeneity, decreased attenuation on noncontrast images or decreased enhancement on postcontrast images. There may also be distortion of the normal vascular. CT is not usually used to diagnose prostatic cancer although it is useful in assessing lymph node involvement and metastases. Prostate cancer spreads by local extension, via lymphatic vessels, and by hematogenous dissemination. Involvement of the axial skeleton is common. Metastases to the lungs, liver, and kidneys occur in the terminal phases of prostatic cancer.

Peter Anderson