1 / 15

Case Presentation

This case presentation describes a patient with radiologic abnormalities and left upper quadrant pain, leading to the discovery of a malignant melanoma in the mediastinum. The presentation includes details of the diagnosis, treatment options, and relevant research studies.

jonathanb
Download Presentation

Case Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Presentation 건국대학교병원 안수연

  2. 63/F • C/C : Radiologic abnormality (LUQ pain) • PMHx • Asthma • TAH + BSO (난소혹, 30YA)

  3. 2YA

  4. 2016.05.25 CT

  5. Radiologic Findings Left paravertebral area에 3.2 x 2.1 x 7.2 cm heterogeneously enhancing mass 있음. Cystic and solid component로 구성되어 있는 bilobulating shape의 mass로 solid portion의 내부에 tiny calcification 포함함. 양측 폐에 muliple nodules 있고, 가장 큰 것은 LUL에 1.6cm nodule임. 양측 폐에 pulmonary emphysema가 있음. 종격과 폐문에 의미있게 커진 림프절 없음. 흉수 없음. 상복부left adrenal gland에 3cm mass 있음. [Conclusion] 1. R/O neurogenic tumor such as paraganglioma in left paravertebral area. 2. Probable multiple pulmonary metastasis

  6. Operation record - No pleural adhesion was noted in the left pleural space. - A 2x1.5cm sized, black colored and hard mass was located on the apicoposteriorsegment of left upper lobe. - A 5x3.5x3cm sized, lobulated cystic mass was noted in the left lower pleural space. It was located over the posterior arc of left 10 and 11th rib. It was well encapsulated and contained yellowish, thick fluid material. Lower portion of the mass was hardandblack in color. It was tightly attached to the adjacent tissues. - The mass was not dissected easily from the mediastinal fat and pleura.

  7. Pathologic Diagnosis Lung, upper, left, wedge resection: Involvement by MALIGNANT MELANOMA (A, "lung, left upper lobe") (1) Size: 1.8 x 1.5 x 1.0 cm (2) Clear resection margin (safety margin: 0.7 cm) Mediastinum, excisional biopsy: Involvement by MALIGNANT MELANOMA (D, "mediastinal mass") (1) Size: 4.7 x 3.2 x 2.3 cm (2) Resection margin: Cannot be evaluated Red_HMB45 (A02) : (A02 & D04): positive Ki-67 (A02) : (A02 & D04): positive in 40% S-100 (A02) : (A02 & D04): positive Red_MART1(Melan-A) (A02) : (A02 & D04): negative

  8. SUVmax 4.1

  9. Primary Malignant Melanoma of the Mediastinum • Malignant melanomas • A malignant tumors composed of melanocytes, which are derived from neural crest cells • account for 1.5% of all cancers • Skin >> central nervous system, rectum, GI tract, bronchus, esophagus • Primary malignant melanoma involving the mediastinum • metastatic from primary cutaneous lesion that has regressed • 4% of 2,446 patients with malignant melanoma did not have a known site of primary origin. Arch Surg. 1975 Aug;110(8):896-900. • de novo melanomas • Origin from a nevus cell aggregate in the mediastinal nodes, sympathetic chain in the posterior mediastinum, and in the thymus

  10. Primary Malignant Melanoma of the Mediastinum • No obvious specific clinical or imaging manifestation • No consensus regarding the treatment of metastatic mediastinal or primary mediastinal MM • Complete surgical resection to reduce the tumor mass is advocated for early stage patients before chemotherapy or radiotherapy. • Immunotherapy and targeted therapy • The cytokines interleukin 2 and interferon alpha, CTLA-4, programmed death protein-1 Medicine (2017) 96:17(e6436)

  11. 32/M J Thorac Dis 2016;8(1):E133-E136 41/F 52/M Li et al. Medicine (2017) 96:17 Korean J Radiol 2012;13(6):823-826

  12. Reference • Korean J Radiol 2012;13(6):823-826 • J Thorac Dis 2016;8(1):E133-E136 • DEVELOPMENTAL DYNAMICS 244:311–322, 2015 • Medicine(2017) 96:17 • Curr Opin Oncol 2014, 26:215–221

More Related