Asim Qureshi.
Melanoma presenting as pericardial effusion.
J Coll Physicians Surg Pak Jan ;17(10):644.

A 68 years old male presented with shortness of breath and tachycardia for the past three months. An echocardiogram showed pericardial effusion. He was admitted to intensive care unit where pericardiocentesis was done. The specimen was sent to laboratory for cytological examination. Microscopic examination revealed large atypical cells with pleomorphic nuclei having prominent nucleoli. Intra-cytoplasmic vacuoles and pigment was also seen. The patient was examined in detail again to look for other lesions and a pigmented lesion was found in the right groin measuring 2 x 2 cm. Fine needle aspiration of the lesion was carried out. Cytological examination revealed similar cells as seen in the pericardial fluid. Immunohistochemical stain HMB 45 (specific for melanoma) was positive. The case was referred to a tertiary care cancer hospital for further management. It has been suggested that the propensity for spindle cell melanomas to metastasize to lymph nodes is relatively low, despite their thickness. It is famous for its ability to appear before even the primary tumor has been discovered. And rarely, the primary tumor spontaneously regresses.3,4 Fine needle aspiration cytology is a rapid diagnostic tool for diagnosing melanoma, especially for hospitalized patients in intensive care unit who are unable to undergo a biopsy for various reasons.

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