Endobronchial and Brain Metastases of Malignant Melanoma during an 11-Year Follow up: A Case Report and Review of the Literature

Case Report

Austin J Cancer Clin Res 2015;2(4): 1037.

Endobronchial and Brain Metastases of Malignant Melanoma during an 11-Year Follow up: A Case Report and Review of the Literature

Yamauchi A1,2, Yokoyama Y2*, Morikawa A1, Soma T1, Ota K1, Yokota M1, Matsukura D1, Sato S1 and Mizunuma H2

1Department of Pulmonology, Instituto Nacional de Silicosis (INS), University of Oviedo, Spain

2Department of Pathology, Hospital Universitario Central de Asturias (HUCA), Spain

*Corresponding author: Ariza MA, Department of Pulmonology, Instituto Nacional de Silicosis (INS), Área del Pulmón, Hospital Universitario Central de Asturias (HUCA), University of Oviedo, Avenida Roma s/n, Oviedo, Asturias 33011, Spain.

Received: March 27, 2015; Accepted: May 07, 2015; Published: May 30, 2015


Although lung parenchyma is a common site for metastasis from extrathoracic tumors including melanoma, endobronchial metastasis from malignant melanoma is a very rare phenomenon. Malignant melanoma is generally known as a rapidly growing tumor, and recurrences are often observed within a short period. The most frequent non-pulmonary primary tumors with endobronchial metastasis are breast, kidney and colon. Endobronchial metastasis from malignant melanoma can simulate bronchogenic carcinoma and presenting symptoms include cough, hemoptysis, dyspnea and wheezing. There are only a few reports of endobronchial metastasis from malignant melanoma. Compared with primary lung, breast, renal or colorectal cancer, melanoma has the highest propensity to metastasize to the brain and these patients have significantly the worst overall prognosis. We report the first known described case of a 42-yearold woman who was diagnosed with endobronchial and brain metastases from a left thigh skin melanoma after being disease-free for 11 years.

Keywords: Malignant melanoma; Endobronchial; Pulmonary; Brain; Metastasis


CT: Computed Tomography; LDH: Lactic Dehydrogenase; MRI: Magnetic Resonance Imaging; MM: Malignant Melanoma; CECT: Contrast-enhanced Computed Tomography; PET: Positron Emission Tomography

Case Presentation

A 42-year-old woman had complained of a black skin lesion on the inner face and proximal third of her left thigh, which was diagnosed as nodular melanoma in February 1997. She underwent a left inguinal linfadenectomy and excision of the tumor with 3-cm margins with no evidence of residual melanoma. The patient remained on routine follow-up visits until 2007. She had a 20 pack-year history of smoking and no other surgical or other medical background of interest. After 11 years of disease-free, the patient was admitted in our hospital, in February 2008, after a week with dizziness and walking instability accompanied by occipital headache, persistent nausea and bilious vomit. She also referred non productive cough in the last month with no chest pain, night sweats or fever. During the neurological examination, a vertical nystagmus on upgaze and a finger-nose-finger dysmetria were seen. The pulmonary auscultation was normal. She was taken only antiemetic drugs at the time.

A cranial computed tomography (CT) scan was performed. The cranial CT revealed a low intensity mass in the right cerebellar hemisphere with an important mass effect, which compressed the fourth ventricle and showed contrast uptake in the form of ¨ring enhancement¨. The chest X-ray showed a right parahilar mass with signs of postobstructive pneumonitis (Figure 1). Laboratory tests (complete blood count, biochemical and arterial blood clotting) were within normal ranges, except for lactic dehydrogenase LDH of 802 IU/L. Three repeated sputum cytologic examinations were negative for malignant cells. The magnetic resonance imaging (MRI) of the brain showed a right cerebellar hemisphere hemorrhagic lesion with an important associated mass effect with lower displacement of the cerebellar tonsils and partial collapse of the fourth ventricle with perilesional enhancement of the mass after contrast administration (Figure 2). Bronchoscopy showed a black-colored endobronchial mass in the right upper lobe causing complete obstruction of the anterior segment (Figure 3). The pathological examination of the bronchoscopy biopsy revealed the presence of malignant melanoma cells. Immunohistochemical analysis revealed the tumor cells were positive for both HMB45 (gp100) and MART-1 (Melan A) (Figure 4). The final diagnosis was endobronchial metastasis of malignant melanoma. In the sixth day of admission, the patient was in a very delicate clinical situation with an important neurological deterioration. She was examined by the neurosurgery department, but due to the poor short term outcome and in accordance with her family, aggressive treatment was discarded. Unfortunately the patient died on the sixth day of admission.