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. 2013 Jul 16:14:253-7.
doi: 10.12659/AJCR.889291. Print 2013.

Endobronchial metastasis from primary anorectal melanoma

Benjamin M Heyman  1 , Matthew M Chung, Amy L Lark, Scott Shofer
Affiliations

Endobronchial metastasis from primary anorectal melanoma

Benjamin M Heyman et al. Am J Case Rep. .

Abstract

Patient: Male, 64 FINAL DIAGNOSIS: Metastatic anorectal melanoma with endotracheal metastasis Symptoms: Fatigue • weight loss • hematochezia • cough

Medication: None Clinical Procedure: Biopsy of anal mass • rigid bronchoscopy Specialty: Internal medicine • oncology • pulmonology.

Objective: Rare disease.

Background: Anorectal melanoma is a rare cancer with a poor prognosis. The mean survival after diagnosis is 15-25 months. At the time of diagnosis, 61% of patients have local regional lymph node metastases, and 21% have distant metastases. The lungs are a common site for metastasis for all tumors including melanoma. However endobronchial metastasis is a rare phenomenon. Endotracheal metastases are even rarer, occurring in only 5% of patients with extrapulmonary endobronchial metastases. It is most commonly seen in breast, colorectal, and kidney cancers. It is extremely rare for cutaneous melanoma. The mean survival after diagnosis is only 15 months and treatment options are limited.

Case report: We report the case of a 64 year-old gentleman with newly diagnosed metastatic anorectal melanoma. A 3 cm by 3 cm bluish-black, oval-shaped, exophytic mass protruding from his anus was found on physical exam. Endobronchial and endotracheal metastasis to the trachea were discovered on computed tomography and he was subsequently taken to the operating room for argon plasma coagulation laser recanalization of his trachea via rigid bronchoscopy, and resection of his anal mass.

Conclusions: We have presented the first known case of anorectal melanoma with endobronchial metastasis. Palliative APC laser recanalization was used to prevent asphyxiation from the endotracheal mass. Endobronchial metastasis is uncommon and can be easily mistaken for primary bronchogenic carcinoma. It should always be considered when evaluating patients with new lung masses.

Keywords: anorectal; bronchoscopy; endobronchial; melanoma; metastasis; treatment.

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Figures

Figure 1
Figure 1
Chest CTA demonstrating endotracheal metastasis.
Figure 2
Figure 2
CT abdomen/pelvis demonstrating severe tumor burden.
Figure 3
Figure 3
CT pelvis demonstrating primary anorectal melanoma.
Figure 4
Figure 4
Endoscopic view of large endotracheal metastasis obtained during flexible bronchoscopy.
Figure 5
Figure 5
Metastatic tracheal biopsy hematoxylin and eosin stain at 20 times magnification.
Figure 6
Figure 6
Anal Biopsy hematoxylin and eosin stain at 20 times magnification.
See this image and copyright information in PMC

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