PMC6481098_01
CXR upright-expiration. Arrow: right lower lobe irregular mass like opacity, no evidence of pneumothorax, effusion, or consolidation.
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fig1
Chest X-Ray (CXR) was obtained and showed a nodular, irregular opacity in the right lung (Figure 1). Computerized Tomography (CT) of the Chest followed and demonstrated a 3.2x2x4.3 cm mass in the superior segment of the right lower lobe as well as a 1.6 cm subcarinal lymph node (Figure 2).
Chest CT. Arrow: 3.2x2x4.3 cm mass in the superior segment of the right lower lobe.
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fig2
Chest X-Ray (CXR) was obtained and showed a nodular, irregular opacity in the right lung (Figure 1). Computerized Tomography (CT) of the Chest followed and demonstrated a 3.2x2x4.3 cm mass in the superior segment of the right lower lobe as well as a 1.6 cm subcarinal lymph node (Figure 2).
PET scan. Arrow: moderate to intensely increased metabolic activity in the right lower lobe mass (max SUV 8.4 initially increasing to 15.5 on delayed images), without evidence of other focal abnormalities.
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fig3
A Positron Emission Tomography (PET) Scan revealed activity in the right lower lobe on both early and delayed imaging (Figure 3).
H&E stain ((a) 200x; (b) 400x) with tumor cells located under bronchial mucosa composed of epithelioid tumor cells with large amounts of acid cytoplasm and prominent nuclei. Mitotic figures are easily found. Note dark brown pigment in tumor cells (Arrows). Immunohistochemically, tumor cells were positive for S-100 and HBM 45 ((c) and (d)), amongst others.
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A core biopsy of the right lower lobe revealed an invasive, poorly differentiated, malignant melanoma (Box 1 and Figure 4).