Dark sputum: An atypical presentation of primary pulmonary malignant melanoma

Abstract

Primary melanoma of the lung is an extremely rare clinical entity. We found only 32 cases reported in literature, and in two of these multiple brain metastases were present. We describe a case of primary lung melanoma with brain and skin metastases that presented with an initial clinical diagnosis of pneumonia.A 55-year-old white man presented with cough productive of dark sputum and fever. A chest x-ray showed a right lung infiltration. After failure to respond to usual treatment for pneumonia, bronchoscopy examination and CT scan revealed a right pulmonary mass. The CT-guided biopsy confirmed a diagnosis of malignant melanoma. The primary lung origin of the tumor was demonstrated by the characteristic junctional pattern of melanoma cells. Further evaluation revealed metastases in the brain and in skin.Primary lung melanoma is an uncommon neoplasm that may be confused with more conventional types of lung cancer. Careful interpretation of histopathological information in correlation with all other clinical, laboratory and imaging studies may be needed to establish a diagnosis. Evaluation for metastases should include looking at the eyes, brain, skin. Due to the small number of cases reported in literature, there is no experience on the management and the prognosis of the disease.

Primary Melanoma of the Lung: A Systematic Review

“…The clinical manifestations of the disease were similar to those of other thoracic malignancies, including cough, hemoptysis, dyspnea, chest pain, and signs and symptoms related to metastases. An interesting case of dark sputum was reported by Fillipini et al, which represents certainly a particular but rare clinical manifestation of PMML [20].…”

Primary Pulmonary Malignant Melanoma Presenting as Bilateral Multiple Subsolid Nodules: A Case Report

“…Feng et al ( 8 ) reported pulmonary MM in the form of two discrete nodules with a surrounding paving pattern in the right upper lobe and left lower lobe. Filippini et al ( 9 ) also reported primary pulmonary MM presenting as a mixed ground-glass opacity and consolidation in the right upper lobe and right lower lobe. However, the present case differs from these two previous cases in that the main radiologic finding was bilateral multiple variable-sized subsolid nodules.…”

“…Regarding the radiological features of primary pulmonary MMs, more than 80% of the cases presented with a solitary solid nodule or mass, while only < 20% presented with multiple or diffuse lesions ( 2 ). Moreover, there were only two cases of primary pulmonary MM presenting with a subsolid ground-glass opacity or consolidation ( 8 9 ). Feng et al ( 8 ) reported pulmonary MM in the form of two discrete nodules with a surrounding paving pattern in the right upper lobe and left lower lobe.…”

“…The formation of MM starts with junctional changes in MM cells just below the bronchial epithelium, followed by the invasion of the bronchial epithelium by melanoma cells and apparent melanoma formation below the epithelium ( 9 ). We hypothesize that the MM cells present in the bronchial epithelium or subepithelium were observed as subsolid ground-glass opacity lesions on the CT scan.…”

Metastatic melanoma: a rare cause of central airway obstruction

“…Lung is one of the most common sites of metastasis of melanoma of extrapulmonary origin with an incidence of 70%–82% 6. A previous analysis of 130 patients with metastatic melanoma to the thorax in a single centre revealed different presentation of metastatic melanoma, for example, multiple pulmonary nodules, solitary nodule, miliary pattern, mediastinal and/or hilar adenopathy, pleural effusion, lytic bony lesions, extrapleural mass and combined lesions 7.…”