Melanoma maligno primario de pulmón. Criterios clínicos y anatomopatológicos / Primary malignant melanoma lung. Clinical and pathological criteria

Introducción: El melanoma maligno es un tumor de etiología multifactorial y se origina de los meloncitos. Es muy infrecuente su origen primario en el aparato respiratorio (0,07%), siendo más frecuente su origen metastásico. Objetivos: Se realiza el análisis y la presentación del siguiente caso clínico con el objetivo de considerar la utilidad de los criterios clínicos y anatomopatológicos para el estudio del tumor. Presentación de caso: Paciente de 74 años de edad, masculino, derivado por imagen pulmonar izquierda en estudio. Se realizó una tomografía de tórax y abdomen superior con evidencia de lesión de 5x6 cm en lóbulo superior izquierdo y otra lesión de 15 mm en lóbulo inferior derecho. Se le solicita fibrobroncoscopía positiva células atípicas. Se decide realizar punción bajo guía tomográfica de imagen pulmonar izquierda. El resultado anatomopatológico informó: Infiltración pulmonar por melanoma. Paciente que evoluciona con deterioro del sensorio reestadificándose con presencia de metástasis cerebrales y aumento del tamaño de la masa pulmonar izquierda. Fallece a los 40 días de haberse realizado el diagnóstico. Discusión: Para definir melanoma primario de pulmón existen diversas publicaciones que recomiendan aplicar una serie de criterios clínicos y anatomopatológicos, que son utilizados para el diagnóstico de esta entidad, que en determinados casos son de difícil aplicación.

Introduction: Malignant melanoma is a multifactorial etiologytumor and originates from the melanocytes. It is very rare its primary origin in the respiratory tract (0.07%), being more frequent their metastatic origin. Objectives: analysis and presentation of the following case inorder to consider the utility of clinical and pathology criteria tostudy the tumor.Case presentation: Patient, 74 years old male, is derived for leftlung image study. A scan of the chest and upper abdomen wasperformed with evidence of a 5x6 cm lesion in the left upper lobeand other of 15 mm in the right lower lobe. Bronchoscopy positivefor atypical cells. It was decided to perform puncture underguidance left pulmonary tomography image. The pathologyresults reported pulmonary infiltration by melanoma. Patient evolve with sensory deterioration re staging presence of brain metastasis and enlargement of the left lung mass. Dies at 40days of the diagnosis has been made.Discussion: To define primary melanoma lung there are several publications that recommend applying a series of clinical and pathological criteria, which are used for the diagnosis of this entity, which in some cases are difficult to apply.

Primary Malignant Melanoma in the Pineal Region

A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed 3.5x2.8 cm sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.

Melanoma amelanótico primario de vagina: reporte de un caso y revisión de la literatura / Primary amelanotic melanoma of the vagina: a case report and literature review

Objetivo: revisar el diagnóstico clínico, histológico e inmunohistoquímico; las alternativas terapéuticas y los factores que influyen en el pronóstico del melanoma amelanocítico de vagina. Materiales y métodos: se presenta el caso de una paciente de 49 años que consultó por masa vaginal de 8 cm en pared anterior de vagina, nacarada y con fondo necrótico a la Unidad de Patología Cervical y Colposcopia del Hospital de Engativá, institución de segundo nivel de complejidad que atiende pacientes de nivel socioeconómico bajo afiliados al régimen de seguridad pública. Se realizó resección amplia de la lesión. La patología quirúrgica informó melanoma fusocelular y epiteloide maligno. Se realizó una búsqueda sistemática usando las palabras clave: melanoma primario y vagina en las bases de datos Medline vía PubMed, Cochrane y Ebsco. Resultados: se encontraron 489 artículos de los cuales 31 estaban relacionados directamente con el tema, de estos se seleccionaron diez que correspondieron a nueve reportes de caso y a una revisión del tema. El diagnóstico clínico no es fácil. Las proteínas HMB45 y S100 son de gran utilidad en su identificación. La respuesta al tratamiento quirúrgico, la radioterapia y la quimioterapia es pobre. El pronóstico depende de la ploidía, la amelanosis y el índice mitótico. Conclusiones: el melanoma primario de vagina es una neoplasia rara y de mal pronóstico. Hace parte del grupo de melanomas de mucosa que tienen un origen y comportamiento biológico diferente al cutáneo. Tiene tendencia a la diseminación hematógena rápida y a recaídas locales. El tratamiento se basa en cirugía conservadora, radioterapia, quimioterapia y terapia biológica; sin embargo, su eficacia es limitada.

Objective: reviewing clinical, histological and immunohistochemical diagnosis, therapeutic alternatives and factors influencing prognosis for amelanotic melanoma of the vagina. Materials and methods: this article presents the case of a 49yearold patient who consulted the Engativá Hospital’s Cervical Pathology and Colposcopy Unit due to an 8 cm diameter necrotic pearlywhite vaginal mass on the anterior vaginal wall. The hospital is a secondary level complexity institution dealing with low socioeconomic level patients affiliated to the public (subsidized) social security (health) system. A broad resection was made of the lesion. Surgical pathology revealed epithelioid fusocellular malignant melanoma. A systematic literature search was made using the following key words: primary melanoma and vagina in Medline databases via Pub Med, Cochrane and Ebsco. Results: 31 of the 489 articles found were directly related to the topic; 10 new case reports and a review were selected. Clinical diagnosis is not easy; HMB45 and S100 proteins are extremely useful in identifying it.Response to surgical treatment, radiotherapy and chemotherapy is poor. Prognosis depends on ploidy, amelanosis and mitotic index. Conclusions: primary melanoma of the vagina is a rare neoplasm and has a poor prognosis. It forms part of a group of mucosal melanoma having an origin and biological behavior different to that of cutaneous melanoma. It tends to have rapid hematogenous dissemination and local relapses. Treatment is based on conservative surgery, radiotherapy, chemotherapy and biological therapy; however, its effectiveness is limited.

Primary Intradural Extramedullary Malignant Melanoma in the Thoracic Spine: Case Report and Literature Review

We present a case of primary malignant melanoma of the thoracic spine mimicking intradural extramedullary meningioma or schwannoma. In 2010, a 55-year-old man presented with hypesthesia below the T4 dermatome level and bilateral leg weakness. Magnetic resonance imaging (MRI) of the thoracic spine revealed an approximately 1.5 cm well marginated mass lesion in the intradural extramedullary area at the level of T4-5. Preoperative MRI findings suggested benign spinal cord tumor such as meningioma or calcified schwannoma. Surgery revealed a well marginated black-colored tumor. After removal of the tumor, we observed pigmented seeding along the leptomeninges. According to the pathology report, the final diagnosis was malignant melanoma. No evidence of primary malignant tumor, abnormal lymphadenopathy or distant metastatic lesion was found on the PET-CT scan. As a result, the lesion was compatible with primary spinal malignant melanoma. Even if spinal melanoma was suspected in the thoracic spine, it is easy to simply diagnosis the finding as schwannoma or meningioma based on the preoperative radiological findings. Therefore, preoperative diagnosis should be decided carefully, especially for masses in the thoracic spinal tumor.

Primary Melanoma of the Stomach at Cardia

Melanoma is a malignant neoplasm of melanocytes most frequently arising from the skin, but primary melanoma can also arise from the mucosa of the gastrointestinal tract. Gastrointestinal melanomas are most commonly metastases from a cutaneous melanoma. Primary melanoma of the stomach is rare and carries a poor prognosis. Reported here is the case of a 75-year-old man with a primary gastric melanoma who presented with a melena, abdominal pain, and weight loss. Most cases of melanoma are treated by excision of the primary tumor. Patients with melanoma have been treated with adjuvant chemotherapy, radiation therapy, and immunotherapy. None of these modalities has been demonstrated to prolong the survival rate. To improve long-term disease-free survival, early diagnosis and surgical intervention are very important.

Cytopathologic Observation of Primary Malignant Melanoma of the Lung: A case report

The pulmonary cytology has reached a high level of accuracy. By the examination of the sputum and/or bronchial brushings, it is now possible to make a diagnosis in 70% to 90% of patients with cancer. Primary melanoma of the lung is very rare and there have been reported about 20 cases in the world literature. We present a case of primary malignant melanoma of the lung in a 61-year-old male diagnosed by cytologic examination of sputum, bronchial brushing and aspirated pleural fluid. Histologic examination of bronchoscopic biopsy and examination of the skin and other primary sites confirmed the diagnosis.