An Unusual Case of Malignant Melanoma with Metastasis to the Placenta During Pregnancy.

Introduction: We describe an unusual case of metastatic melanoma of the brain with an unknown primary site during pregnancy. Case Description: A 35-year-old woman in the third trimester of pregnancy presented with ataxia, nausea, vomiting, headaches and diplopia. CT of the brain revealed a hyper-attenuating 2.1 cm mass in the fourth ventricle with mild obstructive hydrocephalus. A healthy newborn was delivered by urgent caesarean section. Craniotomy and resection of the brain lesion confirmed melanoma. Pathology of the placenta reported a 'focal nest of melanocytes identified in intervillous space'. Discussion: Brain and maternal placenta pathology findings were consistent with melanoma, making this case relevant because of the possibility of metastatic melanoma in a fetus. Conclusion: Epidemiological data on congenital and infantile melanoma are scarce. Also, there is no database for long-term follow-up of children born to pregnant mothers with metastatic melanoma. Delayed presentation of melanoma in the child cannot be ruled out. LEARNING POINTS: Melanoma brain metastasis is an uncommon initial presentation during pregnancy.During pregnancy, vague symptoms such as headaches and nausea can easily be attributed to the pregnancy itself rather than more serious conditions like cancer.Metastatic melanoma diagnosed during pregnancy with disease in the placenta is a rare occurrence and should trigger close follow-up of the neonate secondary to concerns of transplacental metastasis.

Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery.

The internal thoracic artery has a patency rate of 85%-95% at 10-15 years post coronary artery bypass graft surgery. Development of total occlusion of the internal thoracic artery within a short period (< 6 months) after the surgery is exceedingly rare. However, competitive flow between the native vessel and the conduit internal thoracic artery, or competitive flow between the 2 conduit internal thoracic arteries in a multiple arterial grafting procedure can jeopardize 1 of the 2 conduit internal thoracic arteries. We report the cases of 2 patients who had bilateral internal thoracic artery grafts, with total occlusion of 1 of the 2 grafts within a short period (6 months) after successful coronary artery bypass graft surgery.

L'artère thoracique interne a un taux de perméabilité des greffons de 85 % à 95 % 10 à 15 ans après un pontage aortocoronarien. L'apparition d'une occlusion totale de l'artère thoracique interne dans un court délai (< 6 mois) après l'intervention est extrêmement rare. Cependant, le flux compétitif entre le vaisseau natif et l'artère thoracique interne de conductance ou le flux compétitif entre les 2 artères thoraciques internes de conductance dans une procédure de greffe artérielle multiple peuvent menacer l'une des 2 artères thoraciques internes de conductance. Nous rapportons les cas de 2 patients ayant subi une greffe bilatérale de l'artère thoracique interne et présenté une occlusion totale de l'un des 2 greffons peu (6 mois) après un pontage aortocoronarien réussi.