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Oral malignant melanoma detected after resection of amelanotic pulmonary metastasis.

Matsuoka K - Int J Surg Case Rep (2013)

Bottom Line: A detailed physical examination revealed a black tumor in the oral cavity, and this was suspected to have been the primary.Because of absence of symptoms in the early stage of the disease and the presence of the tumor in relatively obscure areas of the oral cavity, the diagnosis is unfortunately often delayed.In view of the rarity of primary lung melanoma, when lung tumor was diagnosed as malignant melanoma, detailed physical examination of the entire skin and mucosa including the oral cavity was necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji-City, Hyogo, Japan. Electronic address: katccha@ares.eonet.ne.jp.

No MeSH data available.


Related in: MedlinePlus

Chest CT on admission demonstrated the nodular lesion of 8 mm in diameter in the left upper lobe of lung. (A) Positron emission tomography demonstrated slight uptake of FDG at the position of the nodular shadow (white arrow) and no other abnormal findings were evident. Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling (B) and (C).
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fig0005: Chest CT on admission demonstrated the nodular lesion of 8 mm in diameter in the left upper lobe of lung. (A) Positron emission tomography demonstrated slight uptake of FDG at the position of the nodular shadow (white arrow) and no other abnormal findings were evident. Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling (B) and (C).

Mentions: An asymptomatic 84-year-old male was presented at our hospital because a nodular lesion of 8 mm in diameter had been detected in the left upper lobe of lung by routine chest computed tomography during follow up for ischemic heart disease (Fig. 1). He had undergone subtotal gastrectomy for early gastric cancer, radiation treatment and hormone therapy for prostate cancer, and coronary artery stenting due to severe multiple coronary artery stenosis. He had a history of smoking with a pack-year rate of 35. Retrospective examination revealed a 6 mm nodular lesion on a chest CT film obtained 4 months previously. Positron emission tomography demonstrated only slight uptake of FDG at the position of the nodular shadow, and no other abnormal findings were evident (Fig. 1). Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling. Because the nodule increased in size during 4 months, malignant disease was suspected, and we performed video-assisted thoracoscopic surgery. Because of the patient's poor cardiac function, wedge resection was performed. The resected nodule had a smooth surface, and the cut surface was white with brown pigmented deposits. Intraoperative histological examination gave a diagnosis of undifferentiated carcinoma. The postoperative course was uneventful, and the patient was discharged from hospital 3 days after surgery. Histological examination demonstrated a gray-white tumor with brown spots and proliferation of spindle and epithelioid cells with abundant cytoplasm and atypia. The tumor involved the visceral pleura and was exposed to the pleural surface histologically. Immunohistochemical examination demonstrated negatively for CAM5.2, CK7, TTF-1, NapsinA and calretinin, and positively for vimentin, HMB-45 and S100. From these results, the tumor was diagnosed as malignant melanoma (Fig. 2).


Oral malignant melanoma detected after resection of amelanotic pulmonary metastasis.

Matsuoka K - Int J Surg Case Rep (2013)

Chest CT on admission demonstrated the nodular lesion of 8 mm in diameter in the left upper lobe of lung. (A) Positron emission tomography demonstrated slight uptake of FDG at the position of the nodular shadow (white arrow) and no other abnormal findings were evident. Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling (B) and (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860044&req=5

fig0005: Chest CT on admission demonstrated the nodular lesion of 8 mm in diameter in the left upper lobe of lung. (A) Positron emission tomography demonstrated slight uptake of FDG at the position of the nodular shadow (white arrow) and no other abnormal findings were evident. Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling (B) and (C).
Mentions: An asymptomatic 84-year-old male was presented at our hospital because a nodular lesion of 8 mm in diameter had been detected in the left upper lobe of lung by routine chest computed tomography during follow up for ischemic heart disease (Fig. 1). He had undergone subtotal gastrectomy for early gastric cancer, radiation treatment and hormone therapy for prostate cancer, and coronary artery stenting due to severe multiple coronary artery stenosis. He had a history of smoking with a pack-year rate of 35. Retrospective examination revealed a 6 mm nodular lesion on a chest CT film obtained 4 months previously. Positron emission tomography demonstrated only slight uptake of FDG at the position of the nodular shadow, and no other abnormal findings were evident (Fig. 1). Although FDG uptake of left cervical lymph node was increased, this uptake was supposed to nonspecific uptake due to nonspecific lymph node swelling. Because the nodule increased in size during 4 months, malignant disease was suspected, and we performed video-assisted thoracoscopic surgery. Because of the patient's poor cardiac function, wedge resection was performed. The resected nodule had a smooth surface, and the cut surface was white with brown pigmented deposits. Intraoperative histological examination gave a diagnosis of undifferentiated carcinoma. The postoperative course was uneventful, and the patient was discharged from hospital 3 days after surgery. Histological examination demonstrated a gray-white tumor with brown spots and proliferation of spindle and epithelioid cells with abundant cytoplasm and atypia. The tumor involved the visceral pleura and was exposed to the pleural surface histologically. Immunohistochemical examination demonstrated negatively for CAM5.2, CK7, TTF-1, NapsinA and calretinin, and positively for vimentin, HMB-45 and S100. From these results, the tumor was diagnosed as malignant melanoma (Fig. 2).

Bottom Line: A detailed physical examination revealed a black tumor in the oral cavity, and this was suspected to have been the primary.Because of absence of symptoms in the early stage of the disease and the presence of the tumor in relatively obscure areas of the oral cavity, the diagnosis is unfortunately often delayed.In view of the rarity of primary lung melanoma, when lung tumor was diagnosed as malignant melanoma, detailed physical examination of the entire skin and mucosa including the oral cavity was necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji-City, Hyogo, Japan. Electronic address: katccha@ares.eonet.ne.jp.

No MeSH data available.


Related in: MedlinePlus