PMC3715368_01
Chest CTA demonstrating endotracheal metastasis.
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Diffuse tree-in-bud opacities and nodular lung opacities were thought to represent endobronchial tumor (Figure 1).
CT abdomen/pelvis demonstrating severe tumor burden.
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There was extensive lymphadenopathy throughout the entire abdomen and pelvis with innumerable nodules in the peritoneum, retroperitoneum, paraspinous and gluteal muscles, and subcutaneous soft tissues concerning for metastases (Figure 2).
CT pelvis demonstrating primary anorectal melanoma.
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There was also a large soft tissue, exophytic mass involving and extending outward from the anus, measuring 3.7x3.5 cm (Figure 3).
Endoscopic view of large endotracheal metastasis obtained during flexible bronchoscopy.
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Due to concern for possible occlusion by the endotracheal mass, a flexible bronchoscopy was performed which revealed a large, hyperpigmented, pedunculated mass in the mid-lower trachea obstructing about 75% of the airway (Figure 4).
Metastatic tracheal biopsy hematoxylin and eosin stain at 20 times magnification.
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There is a submucosal infiltrate of atypical epithelioid cells most consistent with a metastatic focus (Figure 5).
Anal Biopsy hematoxylin and eosin stain at 20 times magnification.
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Both the cytological atypia and histological findings supported the anal mucosa as the primary site of tumor origin (Figure 6).