Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 878 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 3  |  Page : 196-197  

Malignant melanoma with cavitary pulmonary metastasis: Diagnostic dilemma resolved by FDG PET/CT guided biopsy


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Jul-2014

Correspondence Address:
Rakesh Kumar
Department of Nuclear Medicine and Positron Emission Tomography (PET), All India Institute of Medical Sciences, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.136604

Rights and Permissions

How to cite this article:
Chakraborty PS, Dhull VS, Karunanithi S, Verma S, Kumar R. Malignant melanoma with cavitary pulmonary metastasis: Diagnostic dilemma resolved by FDG PET/CT guided biopsy. Indian J Nucl Med 2014;29:196-7

How to cite this URL:
Chakraborty PS, Dhull VS, Karunanithi S, Verma S, Kumar R. Malignant melanoma with cavitary pulmonary metastasis: Diagnostic dilemma resolved by FDG PET/CT guided biopsy. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 10];29:196-7. Available from: http://www.ijnm.in/text.asp?2014/29/3/196/136604

Sir,

We present a case of a 70-year-old male patient who was operated 5 years back for a malignant melanoma of right big toe. He was again operated 3 years ago for the recurrence in his right thigh. Patient was in complete remission and on regular follow up since then. Patient was apparently normal till 3 months back when he presented with two episodes of hemoptysis. Chest X-ray revealed a left lung upper lobe thick walled cavitary lesion. Computed tomography (CT) revealed the same findings along with hemorrhage in the surrounding area. From the above findings, it could not be ascertained whether the mass was infective or metastatic in nature. Therefore, a CT-guided biopsy was done which revealed it to be infective in nature (resolving pneumonia). But even after 3 weeks of appropriate antibiotic coverage, the mass neither resolved nor decreased in size. Repeat CT-guided biopsy revealed necrotic tissue but could not pinpoint the diagnosis. It was then that the patient was referred for the 18 F FDG PET/CT, which revealed a cavitary lesion in left lung upper lobe with increased uptake of the radiotracer along its margins [Figure 1]a-c; arrows. But the clinical query was still unanswered, so a PET/CT-guided biopsy was undertaken. PET/CT-guided biopsy from the lung mass [Figure 1]d and e revealed malignant melanoma cells which were positive for HMB-45 and S-100 and were negative for cytokeratin. So, PET/CT-guided biopsy from the margins of the cavitary lesion showing increased uptake aided in the accurate diagnosis of pulmonary metastasis from malignant melanoma. To the best of our knowledge, this is the first case of malignant melanoma with isolated cavitary lung metastases.
Figure 1: 18F FDG PET/CT revealing a cavitary lesion in left lung upper lobe with increased uptake of the radiotracer along its margins (a-c; arrows). A PET/CT-guided biopsy was performed from the lung mass along the margins where intense uptake was noted (d and e)

Click here to view


Foot melanoma comprises 3 to 5% of all melanoma cases and presents a challenge to the treating physician who has to choose between adequate resection and preservation of limb function. [1] Melanomas which metastasize beyond its locoregional site generally predict a poor outcome with a mean survival of around 6 months only. [2] Patients with melanoma metastases to lung have a median survival of 1 year, while those to sites other than lung have a median survival of around 18 months. [3] Cavitary lung metastases are extremely rare and represent only 4% of cases of lung metastases and usually arise from squamous cell carcinoma (especially of the head and neck), adenocarcinomas, and sarcomas. [4] FDG PET is useful in the initial staging of patients with cutaneous malignant melanoma to help detect soft tissue, lymph node, and visceral metastases. [5] In a meta-analysis comparing ultrasonography (USG), CT, and PET/CT for staging and surveillance of melanoma patients, USG was found superior for the detection of lymph node metastases while PET/CT was found superior for distant metastases. [6] The proper guideline-based or targeted therapy for a patient can only be administered after proper histopathological diagnosis of the tumor site or site of metastases, which at times can be difficult due to prior chemotherapy or radiation therapy changes. [7] FDG PET/CT can visualize vital areas of the tumor with increased metabolic activity and can pin-point the tissues from which biopsy can be taken. This increases its diagnostic value. [8] In this case, PET/CT-guided biopsy helped to pin-point the diagnosis of cavitary metastases to the lung which originated from the malignant melanoma of the right toe and hence helped in changing the treatment plan of the patient.

 
   References Top

1.Rashid OM, Schaum JC, Wolfe LG, Brinster NK, Neifeld JP. Prognostic variables and surgical management of foot melanoma: Review of a 25-year institutional experience. ISRN Dermatol 2011;2011:384729.  Back to cited text no. 1
    
2.Chua TC, Scolyer RA, Kennedy CW, Yan TD, McCaughan BC, Thompson JF. Surgical management of melanoma lung metastasis: An analysis of survival outcomes in 292 consecutive patients. Ann Surg Oncol 2012;19:1774-81.  Back to cited text no. 2
    
3.Tas F. Metastatic behavior in melanoma: Timing, pattern, survival, and influencing factors. J Oncol 2012;2012:647684.  Back to cited text no. 3
    
4.Raissouni S, Ghizlane R, Mouzount H, Saoussane K, Khadija S, Zouaidia F, et al. Unusual case of cavitary lung metastasis from squamous cell carcinoma of the uterine cervix. Pan Afr Med J 2013;14:37.  Back to cited text no. 4
    
5.Krug B, Crott R, Lonneux M, Baurain JF, Pirson AS, Vander Borght T. Role of PET in the initial staging of cutaneous malignant melanoma: Systematic review. Radiology 2008;249:836-44.  Back to cited text no. 5
    
6.Xing Y, Bronstein Y, Ross MI, Askew RL, Lee JE, Gershenwald JE, et al. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: A meta-analysis. J Natl Cancer Inst 2011;103:129-42.  Back to cited text no. 6
    
7.Werner MK, Aschoff P, Reimold M, Pfannenberg C. FDG-PET/CT-guided biopsy of bone metastases sets a new course in patient management after extensive imaging and multiple futile biopsies. Br J Radiol 2011;84:e65-7.  Back to cited text no. 7
    
8.Klaeser B, Mueller MD, Schmid RA, Guevara C, Krause T, Wiskirchen J. PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: Initial experiences. Eur Radiol 2009;19:1780-5.  Back to cited text no. 8
    


    Figures

  [Figure 1]


This article has been cited by
1 CT-Staging kutaner maligner Melanome
J. Hoffend
Der Radiologe. 2015;
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed758    
    Printed15    
    Emailed0    
    PDF Downloaded66    
    Comments [Add]    
    Cited by others 1    

Recommend this journal