A case of pulmonary primary melanoma.

Patient female, 65 years old.
No obvious cause of coughing for 2 weeks, mainly continuous dry cough, no cough sputum, no fever, dizziness headache, chest tightness, night sweating, local hospital chest CT display: right lower lung position lesions.
the above symptoms improved after treatment (the specific medication is not known), for further treatment to Zhejiang University affiliated second hospital examination.
physical examination: skin, mucous membranes are not special, shallow lymph nodes have not been touched.
gynaecological consultation suggests that the vulva is not special, the vaginal wall does not see obvious lumps or pigmentation, the uterine cavity is smooth.
no positive results were found in the abdomen and shallow lymph nodes B.
CT-enhanced scan of the skull did not show a significant proportion.
Chest CT flat sweep plus enhanced scan (Figure 1, 2): right lung lower leaf lump, clear boundary, size about 2.9 cm x 2.1 cm, CT value of about 45HU, enhanced after continuous strengthening, and reinforcement is not uniform, CT value of about 105HU.
diagnosis: lung benign lesions are more likely, if necessary puncture biopsy.
chest MRI flat sweep plus enhanced scan (Figures 3 to 5): The base section of the lower right lung sees an abnormal nosedle signal, about 2.5 cm x 1.9 cm x 2.5 cm, the boundary is more Clear, T2WI has a high signal, inside see strip-like low signal, fat-suppressing T1WI for high signal, inside see flaky low signal, diffusion weighted imaging (DWI) sequence shows that the lumps see no knot-like diffusion restricted area.
after the strengthening of the lesions is not obvious.
diagnosis: the lower right lung after the substrate segment nosures, consider melanoma.
Figure 1CT flat sweep lung window: high density lumps in the lower right lung, clear boundary; Figure 2A to CCT vertical window: before and after the lump enhancement scan contrast, showing significant continuous strengthening; Figure 3MRI flat sweep: T2WI lump internal low signal; Figure 4DWI illustration: block diffusion is limited; Figure 5A to C MRI enhanced scan before and after lipid suppression T1WI: enhanced scanning before the block is high signal, There was a flaky low signal, the lump was not significantly strengthened after the enhanced scan, and the ultrasound shadow (Figure 6): a low echo lump about 2.3 cm x 2.1 cm in size was visible under the thoracic membrane, and the lesions were "fast-forward and fast-out" after 5 ml0.9% of the physiological saline was followed by a 2.4 ml contrast agent, Novi, which was injected intravenously through the elbow.
: thoracic area, puncture biopsy is recommended.
punctured lungs under the guidance of B-line B, see black pathological tissue.
results (Figure 7): Malignant melanoma.
6A-C ultrasound image: the lesions showed a "fast-forward, fast-out" enhanced performance, And Figure 7 pathology: cell nucleotypes are obvious, and more melanin deposition is seen (Envision two-step staining method, x20 Discussion of melanoma, also known as malignant melanoma, to skin melanoma is the most common, the skin outside the good hair site is mainly the eye, vulva, followed by the rectum, anus, reproductive tract, digestive tract, secondary sinuses, mumps and so on.
melanoma, which is native to the lungs, is extremely rare, and there are fewer than 40 cases reported at home and abroad using Pubed, Web of Science and China Knowledge Network for input (lung, primary, melanoma) retrieval, combined with a summary of the literature.
melanomas in the lungs are mostly metastatic and rare, and the literature says strict diagnostic criteria have been published, with malignant melanoma associated with changes in bronchal epiderm cells.
Wilson, etc., proposed diagnostic criteria: (1) no skin, mucous membranes or eye surgery or electrical history;
therefore, after a complete skin, eye, gynecological examination, if no primary pigment lesions are found, the diagnosis of primary melanoma is supported.
This case became an isolated lump in the lower right lung, routine physical examination, gynecological examination, abdominal and superficial lymph node ultrasound, head CT and other clinical auxiliary examinations did not find extra-pulmonary primary melanoma, pathological diagnosis of melanoma, in line with primary melanoma diagnosis.
melanoma CT is characterized by soft tissue density shadow, enhanced scanning reinforcement is not uniform, and does not have characteristics.
CT has certain limits on the quality of malignant melanoma, but it can clearly show the range of lesions, location, aggression and bone damage, and play an important role in clinical determination of treatment options and prognosis.
In this case, the lesion boundary is clear, the density is more uniform, closely related to the thoracic membrane and near-side lung blood vessels, the surrounding lung tissue has not seen significant invasive changes, adjacent ribs have not seen obvious aggression, after strengthening more uniform, and benign lung tumors can not be distinguished.
melanoma is rich in melanin, MRI often manifests itself as T1WI high signal, T2WI low signal.
This example of pulmonary melanoma MRI performance is typical, the lump boundary is clear, the fat-suppressing T1WI sequence is obviously high signal, T2WI signal is uneven, the lesions see flaky low signal area, is the melanin component, and the DWI sequence diffusion is obviously limited, in line with the characteristics of malignant tumors.
Melanoma malignancy is very high, the prognosis is very poor, at this stage there is no better treatment, surgery and/ or radiation, chemotherapy survival period of less than 14 months, but the treatment method is still to lesions including lung leaves or full lung removal plus the cleaning of surrounding lymph nodes.
, pulmonary primary melanoma is extremely rare, diagnosis is based on image performance, pathological characteristics and no other part of the original morbidity history.
typical melanoma can be diagnosed according to MRI performance, the application of the lung MRI, can identify the location, shape, size, scope and relationship with surrounding tissue, and can show the nature of the lump, according to the analysis of the composition of the lump.
the short T1 and short T2 signals for typical melanomas are clearly displayed.
and can observe the melanoma composition and intoma hemorrhage in atypical melanoma, according to its pathological characteristics of comprehensive judgment.
if nosules or lumps are found in the lungs, the possibility of the disease should be taken into account, and parallel MRI examinations should provide a more accurate basis for diagnosis.
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