Martinez Pena Grace Nabila, Jiang Chuan
Medicine - Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, New York, USA.
BMJ Case Rep. 2019 May 8;12(5):e228957. doi: 10.1136/bcr-2018-228957.
A 45-year-old man presents with acute respiratory failure. Imaging revealed a left mainstem endobronchial mass with subcarinal lymphadenopathy, but no other evidence of a primary tumour. An incidental laryngeal nodule was found during bronchoscopy. Biopsies of this lesion by nasopharyngoscopy and subcarinal lymph nodes via mediastinoscopy were performed. Histopathological and immunohistochemical examination showed evidence of melanoma in both samples. Mutational analysis identified the presence of a BRAF mutation. The patient underwent bronchoscopic ablation of the left mainstem endobronchial tumour with laser therapy followed by initiation of encorafenib and binimetinib combination therapy. The patient remains alive at 4 months after initial presentation of disease. This case adds to the body of literature highlighting the clinical heterogeneity and challenges of the management of metastatic pulmonary melanoma. To the best of our knowledge, this simultaneous constellation of metastasis has not been described before.
一名45岁男性出现急性呼吸衰竭。影像学检查显示左主支气管内肿块伴隆突下淋巴结肿大，但无其他原发性肿瘤证据。支气管镜检查时发现一个偶然的喉部结节。通过鼻咽喉镜对该病变进行活检，并通过纵隔镜对隆突下淋巴结进行活检。组织病理学和免疫组织化学检查显示两个样本均有黑色素瘤证据。突变分析确定存在BRAF突变。患者接受了激光治疗支气管镜下消融左主支气管内肿瘤，随后开始恩考芬尼和比美替尼联合治疗。患者在疾病初次出现后4个月仍存活。该病例补充了文献资料，突出了转移性肺黑色素瘤临床异质性及治疗挑战。据我们所知，此前尚未描述过这种同时发生的转移情况。
