A Rare Case of Late Endobronchial Metastatic Melanoma
American Journal of Respiratory and Critical Care Medicine
American Thoracic Society
San Diego, CA
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Background: Metastatic melanoma has been known to involve the thoracic cavity. However, involvement of the tracheobronchial tree is rare, accounting for only 4.5% of all endobronchial metastases. Case Report: A 77-yearold male with a history of malignant melanoma diagnosed in 1968, with recurrence in the right ear in 2008, presented to the clinic with complaints of shortness of breath and cough. He was noted to have\ a nonhypermetabolic 1.5 cm right hilar mass a year ago, and a bronchoscopy/endobronchial ultrasound (EBUS) performed at the time was non-diagnostic. Because of his recurrent symptoms, a repeat positron emission tomography/computerized tomography (PET/CT) scan was performed. Results showed a 1.9 X 2.8 cm lobulated hypermetabolic soft tissue mass arising from the posterior inferior right hilum and extending to the anterior right lower lobe with standard uptake value (SUV) 10.5. Subsequently, a repeat bronchoscopy/EBUS showed endobronchial invasion of the superior segment of the right lower lobe. EBUS lymph node survey demonstrated enlarged lymph nodes in the 4R, 7 and 10R stations. A right lower lobe mass was identified using linear EBUS at the 11R level and fine needle biopsies were obtained. Intraoperative pathology showed abnormal mesenchymal/spindle cells. Final pathology of the lung mass was positive for S100, SOX-10, MART-1, and HMB45 and negative for TTF-1, p63 and pankeratin, consistent with metastatic melanoma. The patient was discharged and referred to oncology for definitive management. Unfortunately, his clinical course was complicated with leptomeningeal spread, and patient expired 3 weeks after diagnosis. Conclusion: Endobronchial metastases is most commonly reported with kidney, gastric, and colon cancers. Endobronchial metastasis from late recurrence of melanoma is rarely reported, and is seen in only about 5.6% of melanoma cases. Extension of melanomas to the tracheobronchial tree has been shown to have poor prognosis with a median survival of 48 months after the diagnosis of the primary tumor. In the case presented, our patient’s primary melanoma tumor was initially diagnosed in 1968 and found to have recurrence in 2008 -- 11 years before metastatic extension to the lung.
Melanoma; Case studies; Cancer
Oncology | Pulmonology
Mahboob, H. B.,
Dy, R. V.
A Rare Case of Late Endobronchial Metastatic Melanoma.
American Journal of Respiratory and Critical Care Medicine, 203
San Diego, CA: American Thoracic Society.