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Barisione E, Boutros A, Mora M, Spagnolo F, Tanda ET, Genova C, Tagliabue E. Primary endobronchial melanoma: a case report and clinical management indications. BMC Pulm Med 2024; 24:97. [PMID: 38402179 PMCID: PMC10894489 DOI: 10.1186/s12890-024-02904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND While cutaneous melanomas are well-documented, primary melanoma of the lung (PMML), particularly with endobronchial origin, remains rare and poorly characterized. This case report addresses gaps in understanding by presenting a comprehensive case of a 71-year-old male with primary endobronchial melanoma and conducting a systematic review of PMML cases. CASE PRESENTATION The patient, a former smoker, presented with dyspnea, cough, and hemoptysis. Imaging revealed left lung atelectasis and a suspicious nodule. Bronchoscopy identified an endobronchial mass, subsequently treated with argon plasma coagulation and resection. Biopsy confirmed melanoma. Extensive examinations ruled out a primary skin lesion. Despite initial treatment, recurrence led to pneumonectomy. Histopathology confirmed melanoma. The patient received treatment with pembrolizumab and ipilimumab, but with poor clinical benefit. CONCLUSIONS Primary endobronchial melanoma is a rare entity, comprising 0.01% of lung tumors. This case underscores diagnostic challenges and emphasizes histological criteria to distinguish primary from metastatic lesions. The pathogenesis remains unclear, with theories proposing foetal melanocyte migration or squamous metaplasia. Prognosis varies, necessitating radical surgical extirpation. A systematic review revealed diverse outcomes, supporting the need for further research. In conclusion, endobronchial melanoma involves an endoscopic and surgical management, but evolving therapies, such as immunotherapy, may reshape treatment paradigms. This case contributes to our understanding of PMML, guiding future research and clinical management. As therapeutic options evolve, continued research is crucial to refine our understanding and improve outcomes for this rare malignancy.
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Affiliation(s)
- Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Boutros
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy.
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Oncologia Medica 2, Genova, Italy.
| | - Marco Mora
- U.O. Anatomia Patologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Spagnolo
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Oncologia Medica 2, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genova, Italy
| | - Enrica Teresa Tanda
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Oncologia Medica 2, Genova, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
- UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elena Tagliabue
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Bernal L, Restrepo J, Alarcón ML, Carvajal C, Bonilla CE, Ramírez AM, Beltrán R. Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927757. [PMID: 33731665 PMCID: PMC7985358 DOI: 10.12659/ajcr.927757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.
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Affiliation(s)
- Laura Bernal
- Department of Clinical Oncology, National Cancer Institute, El Bosque University, Bogotá, Colombia
| | - Juliana Restrepo
- Department of Surgical Oncology, National Cancer Institute, Nueva Granada Military University, Bogotá, Colombia
| | - Martha L Alarcón
- Department of Clinical Oncology, National Cancer Institute, El Bosque University, Bogotá, Colombia
| | - Carlos Carvajal
- Department of Thoracic Surgery, National Cancer Institute, El Bosque University, Bogotá, Colombia
| | - Carlos E Bonilla
- Department of Clinical Oncology, National Cancer Institute, El Bosque University, Bogotá, Colombia.,Clinical Oncology, Universidad el Bosque, Bogotá, Colombia
| | - Ana Maria Ramírez
- Department of Thoracic Surgery, National Cancer Institute, El Bosque University, Bogotá, Colombia
| | - Rafael Beltrán
- Department of Thoracic Surgery, National Cancer Institute, El Bosque University, Bogotá, Colombia
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Yang C, Sanchez-Vega F, Chang JC, Chatila WK, Shoushtari AN, Ladanyi M, Travis WD, Busam KJ, Rekhtman N. Lung-only melanoma: UV mutational signature supports origin from occult cutaneous primaries and argues against the concept of primary pulmonary melanoma. Mod Pathol 2020; 33:2244-2255. [PMID: 32581366 PMCID: PMC8386291 DOI: 10.1038/s41379-020-0594-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/14/2023]
Abstract
Primary pulmonary melanoma (PPM) is an entity recognized by the thoracic WHO classification. However, given the absence of native melanocytes in the lung and the known phenomenon of regression of cutaneous melanomas, the existence of PPM has remained controversial. Herein we investigate clinicopathologic and genomic features of lung-only melanomas with the goal to clarify their site of origin. We identified 10 melanomas involving exclusively lung with no current or previous cutaneous, uveal, or mucosal primaries. Four patients had solitary lesions with mean size of 5.1 cm (range 3.0-10.1 cm), meeting the criteria of PPM. Four patients had 2-3 lesions and 2 patients had >10 lesions. All cases underwent targeted next-generation sequencing interrogating up to 468 cancer genes, which revealed mean tumor mutation burden of 42.6 per megabase (range 1.8 to 126) and frequent mutations involving BRAF, NRAS, NF1, KIT, and KRAS - a genomic profile typical of UV-associated cutaneous melanoma. Mutational signature was assessable for eight cases harboring >20 mutations. This revealed that all evaluable cases harbored a dominant UV signature. In addition, one nonevaluable case harbored a GG > AA TERT promoter variant that is highly specific for UV-mutagenesis. As control groups, using the same methodology, a dominant UV signature was identified in 97% (470/486) of cutaneous melanomas, whereas no lung adenocarcinoma (n = 291) exhibited this signature. Notably, the clinical and pathologic features of solitary melanomas, especially those with large size and epithelioid morphology, closely mimicked primary lung carcinomas, highlighting a major potential for misdiagnosis. In conclusion, presence of a UV signature provides direct evidence that nearly all lung-only melanomas in this series, including solitary lesions meeting the strict criteria of PPM, represent metastases from occult cutaneous melanomas. This suggests that lung-only melanomas should be considered as likely metastatic even in the absence of a known primary melanoma elsewhere.
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Affiliation(s)
- Chen Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jason C Chang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Primary Melanoma of the Lung: A Systematic Review. ACTA ACUST UNITED AC 2020; 56:medicina56110576. [PMID: 33142971 PMCID: PMC7693850 DOI: 10.3390/medicina56110576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The respiratory apparatus, generally affected by highly aggressive tumors like lung cancer and mesothelioma, is rarely affected by primary malignant melanoma. The aim of this review was to identify cases of primary malignant melanoma of the lung (PMML) published in the modern scientific literature, and to describe their main clinical, pathological and therapeutic features. Materials and Methods: A systematic search of publications in the electronic database PubMed has been performed using keywords, and the references of the selected articles were checked to identify additional missing studies. Results: Globally 52 papers reporting on 76 cases were identified. Among them there were 47 reports of a single case, three papers reporting on two cases each, and two larger case series published in 1997 and 2005 including eight and 15 cases, respectively. Conclusions: PMML was generally diagnosed in middle-aged males, without any apparent correlation with cigarette smoking. It was more frequently found in the lower lobes and the left lung. The tumors were generally pigmented, composed by epithelial and/or spindle cells with large nuclei and prominent nucleoli, nuclear atypia, and numerous mitotic figures; they commonly showed immunostaining for S-100, HMB 45 and Melan-A. Early detection and surgical resection were the main determinants of survival from this rare malignancy.
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Hibiya T, Tanaka M, Matsumura M, Aoki A, Ikegami T, Okudela K, Kawano N, Ohashi K. An NRAS mutation in primary malignant melanoma of the lung: a case report. Diagn Pathol 2020; 15:11. [PMID: 32028967 PMCID: PMC7006422 DOI: 10.1186/s13000-020-0928-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023] Open
Abstract
Background Primary malignant melanoma of the lung (PML) is extremely rare. No precursor lesions of PML have been identified, and little is known about the genetic mutations associated with the disease. Typically, 15–20% of malignant melanomas possess NRAS gene mutations, but no cases of NRAS-mutated PML have been reported in the English literature. We present a case of PML involving an NRAS mutation. Case presentation Clinical summary A 74-year-old Japanese female presented with worsening dyspnea and was admitted to hospital. Computed tomography (CT) revealed a right lung (S10) mass and pleural dissemination. Cytology of the pleural effusion in the right lung was performed, and malignant melanoma or clear cell sarcoma was suspected. A dermatological examination and gallium scintigraphy were conducted to determine the primary tumor site, but no suspicious lesions, expect for the right lung mass, were found. After admission, CT showed complicating bilateral pneumonia, and an antibiotic drug was administered, but the pleural effusion got worse. About 2 weeks later, the patient died of respiratory failure and cardiac arrest. An autopsy was performed to determine the histological diagnosis. Autopsy findings A 26x15x20-mm black and pale yellow mass was found in the right lower lobe. Many disseminated nodules were found in the right lobe. The tumor had invaded the right diaphragm. Subcarinal lymph node metastasis was also detected. Immunohistochemically, the tumor cells exhibited positivity for S-100 and HMB45 staining. The patient was diagnosed with malignant melanoma. Sanger sequencing of the tumor detected an NRAS mutation. Conclusions We found an NRAS D54N mutation in PML, which has not been reported previously anywhere in the world. Previous reports indicated that most cases of PML can be classified into the triple-wild-type, but BRAF mutation status was only analyzed in a few cases. We should analyze the mutation patterns of PML to determine whether any subtypes other than the triple-wild-type exist. PML might be a form of de novo cancer.
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Affiliation(s)
- Takashi Hibiya
- Department of Pathology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. .,Department of Pathology, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan.
| | - Meiro Tanaka
- Department of Pathology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mai Matsumura
- Department of Pathology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ayako Aoki
- Department of Respiratory Medicine, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Tadashi Ikegami
- Department of Diagnostic Radiology, Kanagawa Dental University Hospital, 1-23 Ogawacho, Yokosuka, 238-8570, Japan.,Department of Radiology, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Koji Okudela
- Department of Pathology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naomi Kawano
- Department of Pathology, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Pathology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Figueroa Rodriguez F, Uddin A, Nasr J. Primary Pulmonary Malignant Melanoma Found While Evaluating New Onset Cough: A Case Presentation and Literature Review. Case Rep Pulmonol 2019; 2019:3867831. [PMID: 31093406 PMCID: PMC6481098 DOI: 10.1155/2019/3867831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Malignant melanoma is a nonepithelial neoplasm of melanocytes. It is tremendously rare for this condition to primarily involve the respiratory tract, accounting only for 0.01% of the lung malignancies. It often presents as a solitary nodule provoking mass effect and/or obstructive symptom. It most commonly affects patients 50 years old and older, with no gender predilection. Complete surgical excision is the treatment of choice; nevertheless, chemotherapy or radiation might be necessary depending on tumor location and/or metastasis status. Recently, biochemotherapy and immunotherapy have emerged as promising treatment modalities. We present a case of Primary Pulmonary Malignant Melanoma (PPMM) in a 76-year-old male with no previous personal or family history of cancer who presented with new onset nonproductive cough. We also present an analysis with high yield points summarizing clinical features, diagnostic workup, and management of PPMM. Finally, we post a table summarizing all the cases ever reported in English literature.
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Affiliation(s)
| | - Ahsan Uddin
- Department of Internal Medicine-Pediatrics, Beaumont Health, Royal Oak, MI, USA
| | - Justine Nasr
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA
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Primary Pulmonary Malignant Melanoma: Report of an Important Entity and Literature Review. Case Rep Oncol Med 2017; 2017:8654326. [PMID: 28352484 PMCID: PMC5352873 DOI: 10.1155/2017/8654326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 01/08/2023] Open
Abstract
Malignant melanoma involving the respiratory tract is nearly always metastatic in origin, and primary tumors are extremely rare. Published data on primary pulmonary malignant melanomas are limited. Up to now 40 relevant cases have been reported in the English literature. Herein, we report a case of a 56-year-old female patient who presented with intracranial metastases due to primary pulmonary melanoma. She underwent bronchoscopy and died 5 months after the initial diagnosis despite the administered biochemotherapy and subsequent immunotherapy. To establish the diagnosis of primary pulmonary malignant melanoma, any extrapulmonary origin was excluded by detailed examination and radiographic imaging. Moreover, an extensive review of the literature regarding this rare entity has been performed.
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Kim SR, Yoon HY, Jin GY, Choe YH, Park SY, Lee YC. Pulmonary malignant melanoma with distant metastasis assessed by positron emission tomography-computed tomography. Thorac Cancer 2016; 7:503-7. [PMID: 27385996 PMCID: PMC4930973 DOI: 10.1111/1759-7714.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022] Open
Abstract
Melanoma is a cutaneous malignant neoplasm of melanocytes. Primary malignant melanoma (MM) of the lung is very rare. Although previous reports have described the radiologic features of pulmonary MM, its rarity means that many factors are unknown. Thus, radiologic diagnosis is very difficult. Furthermore, there is little information regarding diagnostic application and/or the usefulness of [18F]‐fluorine‐2‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography‐computed tomography (FDG‐PET‐CT) for primary pulmonary MM. A 69‐year‐old patient with a productive cough lasting three weeks was admitted to our hospital. Chest CT showed a large single mass with a multi‐lobulated margin and homogeneous enhancement in the right upper lobe, which was subsequently diagnosed as a primary pulmonary MM with multiple metastases. On PET‐CT images, the pulmonary mass and multiple bone lesions showed very increased uptakes of FDG. Considering that pulmonary metastasis from a mucocutaneous melanoma is the main differential diagnosis of primary pulmonary MM, systemic assessment of the whole body is more important than for other types of lung malignancies. This report introduces PET‐CT as a useful diagnostic modality for pulmonary MM, especially in cases of distant multiple metastases.
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Affiliation(s)
- So Ri Kim
- Department of Internal Medicine, Research Center for Pulmonary Disorders Chonbuk National University Medical School Jeonju South Korea; Research Institute of Clinical Medicine-Biomedical Research Institute Chonbuk National University Hospital Jeonju South Korea
| | - Ha-Yong Yoon
- Department of Internal Medicine, Research Center for Pulmonary Disorders Chonbuk National University Medical School Jeonju South Korea
| | - Gong Yong Jin
- Research Institute of Clinical Medicine-Biomedical Research Institute Chonbuk National University Hospital Jeonju South Korea; Department of Radiology Chonbuk National University Medical School Jeonju South Korea
| | - Yeong Hun Choe
- Department of Internal Medicine, Research Center for Pulmonary Disorders Chonbuk National University Medical School Jeonju South Korea; Research Institute of Clinical Medicine-Biomedical Research Institute Chonbuk National University Hospital Jeonju South Korea
| | - Seung Yong Park
- Department of Internal Medicine, Research Center for Pulmonary Disorders Chonbuk National University Medical School Jeonju South Korea; Research Institute of Clinical Medicine-Biomedical Research Institute Chonbuk National University Hospital Jeonju South Korea
| | - Yong Chul Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders Chonbuk National University Medical School Jeonju South Korea; Research Institute of Clinical Medicine-Biomedical Research Institute Chonbuk National University Hospital Jeonju South Korea
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