CRA62 MALIGNANT MELANOMA OF THE LUNG, IS IT PRIMARY OR SECONDARY? A CASE REPORTS

Sivasubramaniam Balakrishan, Teoh Sze Kye, Tan Sin Nee, Aishah Ibrahim, Megat Razeem Abdul Razak, Suhaila Binti Abdullah, Iqbalmunauwir Ab Rashid, Muhamad Rasydan, Abdul Ghani,Surrej Darshain Singh Sran, Oh Yin Lin, Nur Hazirah  Mohamad Nasir, Safuraa Najlaa Mat Salleh, How Soon Hin
1 Sultan Ahmad Shah Medical Centre, IIUM Kuantan Pahang.
2 Hospital Tengku Ampuan Afzan, Kuantan Pahang.

Introduction

Malignant melanoma (MM) in the lung is usually metastatic disease. Primary Malignant Melanoma of Lung (PMML) is rare and poses difficulties in diagnosis. 

Case presentation 

We report 56-year-old male who is an active smoker with comorbidity of type 2 diabetes mellitus, hypertension and dyslipidaemia with PMML. His initial complaint was prolonged cough, and reduced effort tolerance for two months duration. Lung examinations suggestive of right lung collapse. There is multiple hyperpigmented lesion; moles scatter around the body and those were remained in similar size. Chest radiography showed radio opaque lesion at right upper zone. Contrasted computed scan of the thorax showed a large homogenous poorly enhancing right lung mass with multilobulated margin, occupying the right hilum and predominantly right upper lobe. The mass encases lower trachea with endoluminal encroachment causing total obliteration of right upper lobe, and segmental narrowing of right middle and lower bronchial segments. There are multiple mediastinal lymphadenopathies bilaterally. Endobronchial biopsy via flexible bronchoscopy of hyperpigmented lesion at RMB. The histopathological assessment confirms the diagnosis of malignant melanoma which appears dark brownish pigment and the cytoplasms are elongated eosinophilic. The malignant cells are diffusely positive for SOX10, MelanA and HMB45 but negative for CK7, TTF-1 and P40. Biopsy of hyperpigmented skin lesion showed dermatofibroma. Patient underwent successful rigid bronchoscopy and silicone stenting of right main bronchus which open up the right middle and lower lobe bronchi. Post procedure patient was able to be extubated under room air immediately and recovered uneventfully and awaiting clinical trial due to financial restraints. 

Conclusions

PMML is rare and difficult to diagnose due to its morphological and immunophenotyping variation and in absence of skin MM suggestive of PMML.