Pulmonary Malignant Melanoma with Occult Primary-Case Report

惡性黑色素細胞瘤是一種黑色素細胞不正常增生造成的致命皮膚腫瘤，2007年在台灣每十萬人發生率是0.91人。肺臟是惡性黑色素細胞瘤常轉移的臟器，有些人在診斷時只有肺部腫瘤被發現，如果進一步符合特定的臨床條件，则可以診斷為原發性肺部惡性黑色素細胞瘤，如果沒有符合該臨床條件则被歸類成為無原發腫瘤的肺部惡性黑色素細胞瘤。我們提出一位51歲男性在入院治療甲狀舌管囊腫乳突癌時意外發現肺部單一腫瘤，支氣管鏡檢查顯示一個深綠色光滑球狀的腫瘤阻塞右上葉後段的支氣管；後續檢查顯示全身的皮膚、黏膜以及眼睛並無病灶，正子掃描亦未發現其他病灶，病人接受右上及右中肺葉切除手術治療，診斷為無原發腫瘤的肺部惡性黑色素細胞瘤。我們回溯文獻並對肺部惡性黑色素的流行病學、臨床、病理、治療、預後做一整理；針對單一肺部黑色素瘤，診斷上必須仔細尋找原發病灶，而治療上则應盡可能讓病患接受手術治療。

關鍵字

惡性黑色素細胞瘤；無原發腫瘤的肺部惡性黑色素細胞瘤；支氣管內轉移

並列摘要

Malignant melanoma is a fatal skin malignancy with uncontrolled growth of melanocytes. The incidence in Taiwan was 0.76-0.91 per 100,000 people in 2007 [1]. The lung is one of the visceral organs to which melanoma frequently metastasizes. Some patients show only a pulmonary tumor at diagnosis. If they fulfill certain criteria, these patients can be diagnosed as having primary pulmonary melanoma. If not, they are categorized as pulmonary melanoma with occult primary. We reported a 51-year-old man with a solitary pulmonary melanoma found incidentally at admission for thyroglossal ductal carcinoma. Bronchoscopy showed a dark-green endobronchial tumor obstructing the posterior segmental bronchus of the right upper lobe. Subsequent work-up showed no primary lesion in the skin, mucus membrane or eyes. Positron emission tomography showed negative results. The patient underwent right upper lobe and middle lobe bilobectomy and the diagnosis of melanoma with occult primary was established. We reviewed the literature and summarized the epidemiology, clinical and pathological features, treatment and prognosis of pulmonary melanoma. In diagnosing a solitary pulmonary melanoma, the primary site should be carefully sought, and surgical intervention should be performed if possible.

並列關鍵字

melanoma ； pulmonary melanoma with occult primary ； endobronchial metastasis

國際替代計量

Pulmonary Malignant Melanoma with Occult Primary-Case Report

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