Endobronchial metastasis of malignant melanoma was diagnosed in a 70-year-old woman presenting with hemoptysis and non-resolving ground glass opacities 18 months after initial presentation.
Case Report (n=1)
Endobronchial metastases from melanoma are rare but should be considered in patients with a history of melanoma presenting with hemoptysis or non-resolving ground glass opacities.
Abstract Introduction Melanoma is a primary cutaneous malignancy with a relatively high metastatic potential, with at least 10% of patients with initial stage I or II and up to 50% of patients with initial stage III disease developing metastases within five years. The lung is the most common site of visceral metastases, but the burden of disease is primarily parenchymal; endobronchial metastases are comparatively much more rare. Consequently, little is known about how patients with metastatic melanoma of the tracheobronchial tree present or progress. Description of case A 70-year-old woman with a history of well-controlled moderate persistent asthma and a remote history of malignant melanoma of the left shoulder status post wide local excision in 2015 presented to an outpatient clinic for intermittent cough and scant hemoptysis in late 2023. A CT scan demonstrated patchy ground glass opacities in the left upper lobe, and she was treated for a community acquired pneumonia. However, the scant hemoptysis persisted, and surveillance 6-month CT demonstrated further progression of the ground glass with focal consolidation. Subsequent bronchoscopy revealed normal airways. Microbiologic testing was negative, and cytology demonstrated no evidence of malignancy. Serial bronchoalveolar lavage was notable for diffuse alveolar hemorrhage of the lingula. Autoimmune serologies were negative, and surgical lung biopsy demonstrated mild lymphocytic bronchiolitis, emphysematous changes, and no malignancy. Scant hemoptysis persisted, so she underwent left bronchial artery embolization, but approximately 18 months after her initial presentation, she developed large-volume hemoptysis. Repeat bronchoscopy revealed an endobronchial lesion at the takeoff of the lingular segment of the left upper lobe (Figure 1). Biopsies were consistent with malignant melanoma. She is currently undergoing endobronchial tumor debulking with interventional pulmonology while awaiting a final plan for systemic therapy with her medical oncology team. Discussion This was a diagnostically challenging case, as melanoma is not typically on the differential for hemoptysis or non-resolving ground glass opacities, and bronchoscopy early in her disease course was unrevealing. However, as was ultimately identified, endobronchial disease is one potential unifying pathology for these two common pulmonary presentations. Endobronchial metastases from extrapulmonary malignancies are rare and are primarily described in case reports and case series, with up to 5% due to metastatic melanoma. Although rare, metastatic melanoma to the tracheobronchial tree should be considered in patients with a history of melanoma and a consistent clinical presentation, and clinicians should have a low threshold for bronchoscopic evaluation. This abstract is funded by: None
Kercheval et al. (Fri,) conducted a case report in Endobronchial malignant melanoma (n=1). Bronchoscopy and biopsy was evaluated. Endobronchial metastasis of malignant melanoma was diagnosed in a 70-year-old woman presenting with hemoptysis and non-resolving ground glass opacities 18 months after initial presentation.