PMC9841049_01
Chest computed tomography scan of the patient. A suspicious endobronchial lesion in the lingular division is visible.
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Chest computed tomography (CT) scan revealed an endobronchial lesion in the lingular division (Fig. 1).
Bronchoscopy image of the endobronchial melanoma of unknown primary at the initial diagnosis. It shows a round, firm, and ocher-colored mass, almost completely obstructing the lingular bronchus.
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The patient underwent bronchoscopy, which revealed an endobronchial mass obstructing the lingular bronchus (Fig. 2).
Pathologic examination of the bronchoscopy biopsy specimen. (A) Tumor cells demonstrate round to pleomorphic contours with plump cytoplasm. Some of tumor cells show dark brownish and coarse melanin granules ( x 200 H&E). (B) Tumor cells' cytoplasm shows strong staining with HMB45 immunohistochemistry (Common marker for melanoma, x 400).
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Additionally, dark brownish, coarse melanin granules were present in some of the tumor cells (Fig. 3A). On immunohistochemical staining, the tumor cells were found to be strongly positive for S-100 and HMB-45 (Fig. 3B), which supported the diagnosis of malignant melanoma.
Bronchoscopy images of the recurrent endobronchial melanoma of unknown primary. (A) Multiple irregular-shaped, brown-colored endobronchial tumors are partially obstructing the left main bronchus. Numerous ocher- or dark-colored nodules and patch-like lesions are also visible. (B) The recurrent melanoma extends up to the carina and distal trachea. . (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Subsequent bronchoscopy revealed multiple, irregular-shaped endobronchial masses partially obstructing the left main bronchus (Fig. 4A) and numerous ocher- or brown-colored nodules scattered in the distal trachea, carina, and left main bronchus (Fig. 4B), suggesting the recurrence of malignant melanoma.