Testini Mario, Trabucco Senia, Di Venere Beatrice, Piscitelli Domenico
Institute of 2nd General Surgery, Faculty of Medicine, University of Bari, Italy.
Am Surg. 2002 Apr;68(4):377-9.
Primary malignant melanoma of the lung (PMML) is an uncommon tumor with very few cases reported in the literature that satisfy the required criteria to establish a primary bronchial origin. We report a case of a 44-year-old man with acute abdominal distress and a right pulmonary roentgenographic opacity. A cranial-thoracic-abdominal CT scan confirmed the presence of a pulmonary nodule with bilateral cerebral metastases and marked dilatation of intestinal loops. At laparotomy an ileal intussusception was noted and an ileal resection was done. The resected intestinal segment contained three endoluminal polypoidal formations. Histological and immunohistochemical analyses showed the presence of multiple sites of melanoma. These lesions as well as the brain lesions clearly appeared metastatic. The patient underwent further evaluation to identify a primary site of melanoma; bronchoscopy was performed with biopsy of the pulmonary nodule. Pathology revealed a neoplastic process of fusiform cells, with focal presence of melanic inter- and extracellular pigment. The immunohistochemical analysis confirmed the diagnosis of PMML. We discuss the criteria for diagnosis and histogenesis of PMML along with this unusual presentation.
原发性肺恶性黑色素瘤（PMML）是一种罕见肿瘤，文献中报道的符合确立原发性支气管起源所需标准的病例极少。我们报告一例44岁男性，有急性腹部不适，胸部X线显示右肺有不透明影。头颅-胸部-腹部CT扫描证实存在一个肺结节，伴有双侧脑转移以及肠袢明显扩张。剖腹手术时发现回肠套叠，遂行回肠切除术。切除的肠段内有三个腔内息肉样肿物。组织学和免疫组化分析显示存在多个黑色素瘤部位。这些病变以及脑部病变显然为转移性。患者接受了进一步评估以确定黑色素瘤的原发部位；对肺结节进行了支气管镜检查并活检。病理显示为梭形细胞的肿瘤性病变，有局灶性细胞内和细胞外黑色素沉着。免疫组化分析证实为PMML。我们结合这一不寻常的表现讨论了PMML的诊断标准和组织发生。
