Bronchial Malignant Melanoma



Bronchial Malignant Melanoma







Key Facts


Clinical Issues



  • Incidence



    • Approximately 0.01% of all lung neoplasms


    • More common in adults in 6th decade of life


  • Symptoms



    • Cough


    • Dyspnea


    • Chest pain hemoptysis


    • Fever


  • Endoscopic findings



    • Possible pigmented lesion


Microscopic Pathology



  • Nested pattern


  • Spindle cell pattern


  • Pigmented lesion


Top Differential Diagnoses



  • Carcinoma



    • Will show negative staining for S100 protein, HMB-45, &/or mart-1


  • Neuroendocrine carcinoma



    • Melanomas are generally negative for neuroendocrine markers, i.e., chromogranin-A and synaptophysin


  • Neurogenic sarcoma



    • S100 may show positive staining in both tumors


    • Negative for HMB-45 and mart-1


  • Metastatic melanoma



    • Clinical history is most important and reliable way to determine primary site


    • Ocular evaluation is highly important






Primary bronchial melanoma involving full thickness of the bronchial epithelium. Note the presence of residual endobronchial glandular structures image as well as bronchial cartilage image.






High-power view of a bronchial malignant melanoma shows prominent nuclear atypia and mitotic activity. Cellular pleomorphism is a common feature of bronchial melanoma


TERMINOLOGY


Synonyms



  • Pulmonary malignant melanoma


Definitions



  • Malignant neoplasm of possible neural crest derivation


ETIOLOGY/PATHOGENESIS


Etiology



  • No specific etiology for these tumors when they occur in the lung


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Estimated that primary pulmonary melanomas represent approximately 0.01% of all lung neoplasms


  • Age



    • More common in adults in 6th decade of life


  • Gender



    • No gender predilection


Presentation



  • Cough


  • Shortness of breath


  • Chest pain


  • Hemoptysis


  • Fever


Endoscopic Findings



  • Possible pigmented lesion


Treatment



  • Surgical approaches



    • Lobectomy or pneumonectomy


  • Adjuvant therapy



    • Probable chemotherapy


Prognosis



  • Variable



    • Death within 30 months after initial diagnosis


    • Possible survival at 5 years of 40%


MACROSCOPIC FEATURES


General Features



  • Well-defined tumor mass


  • Pigment


  • Homogeneous surface


  • Areas of necrosis &/or hemorrhage may be seen


  • Polypoid bronchial mass in some cases


MICROSCOPIC PATHOLOGY


Histologic Features

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Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Bronchial Malignant Melanoma

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