INTRODUCTION: Endobronchial maligancy causing symptomatic bronchial obstruction is a common problem facing many pulmonary physicians. Most of the therapies offered patients involves palliation of symptoms. We present an unusal case of metastatic endobronchial melanoma causing symptomatic left main stem bronchus obstruction treated with photodynamic therapy (PDT).
CASE PRESENTATION: An 80-year-old male complained of dyspnea and dry cough associated with fatigue for one month. He had history of prostate cancer treated with radiation in 2003, and melanoma of his left ear excised in 2004. Two courses of antibiotics failed to relieve symptoms. On examination there was diminished breath sounds on the left side. A chest radiograph revealed a hilar infiltrate. Computed tommography (CT) scanning demonstrated a large spiculated hilar mass compressing the left upper lobe bronchus with loss of lung volume. Bronchoscopy revealed an obstructing lesion in the left mainstem bronchus (graphic 1). Pathology confirmed the presence of malignant melanoma. Prior to receiving chemotherapy he presented with productive cough and increasing dyspnea. Examination revealed markedly diminished breath sounds on the left side. Chest radiograph demonstrated a completely atelactatic left lung. PDT with argon laser to relieve endobronchial obstruction was initiated. The patient had a total of three PDT treatments and four salvage bronchoscopies to remove fragments of the endobronchial lesion. He had relief of his dyspnea following PDT. Repeat radiograph showed increased aeration in the left lung and bronchoscopy revealed a patent left mainstem bronchus (graphic 2). His symptoms improved and he was discharged home.
DISCUSSIONS: Endobronchial metastasis from nonbronchogenic primary solid tumors are a rare cause of bronchial obstruction. The more common nonbronchogenic tumors involved in endobronchial metastasis include breast, colorectal and renal cell carcinoma. To our knowledge there are only two cases of metastatic endobronchial melanoma treated with PDT reported in the literature.
CONCLUSION: Metastatic endobronchial melanoma is a rare cause of endobronchial obstruction. This case demonstrates that treatment with PDT is potentially safe and effective in alleviating symptoms associated with endobronchial obstruction due to metastatic melanoma.
DISCLOSURE: Ismael Martin, None.