Lung Cancer |

Endobronchial Melanoma in an HIV Patient: A Rare Cause of Hemoptysis FREE TO VIEW

Jennifer Lacy, MD
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Dartmouth-Hitchcock Medical Center, Lebanon, NH

Chest. 2014;146(4_MeetingAbstracts):623A. doi:10.1378/chest.1990689
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: This case of metasatic melanoma presented much like a primary lung cancer might have. The pigmented endobronchial lesion was a clue on bronchoscopy to the ultimate diagnosis.

CASE PRESENTATION: A 53 year old male smoker (16 PY) with HIV on HAART (CD4+ count 316, viral load undectable) presents with a one-week history of hemoptysis and rapidly progressive dyspnea. He reports coughing up a ½ cup of dark-to-bright red blood a day. He was asymptomatic two weeks ago, but now he cannot walk across the room. He also notes weight loss, and new back pain. He was diagnosed with HIV two years ago after developing recurrent sinus infections (no opportunistic infections). His exam revealed markedly decreased airflow in the left compared to the right chest. PFTs demonstrated a severe restrictive pattern. Chest CT scan showed a left lower lobe lobulated lung mass, mediastinal lymphadenopathy, an endobronchial lesion in the left mainstem bronchus, and a vertebral metastatic lesion. Bronchoscopy demonstrated a splayed carina and extrinsic compression of the bronchi and complete obstruction of the distal left mainstem bronchus by a purplish, pedunculated lesion. The lesion was removed with a cautery snare. The patient’s dyspnea and hemoptysis resolved after removal of the lesion. Pathology revealed a malignant melanoma of unknown primary. He has been treated radiation to the spine and with four cycles of Ipilumumab.

DISCUSSION: Melanoma is more common in patients with HIV/AIDS with a standardized rate ratio of 2.6 (95% CI 1.9 -3.6) and is classified as a non-AIDS defining cancer in this population [1]. Non-AIDS defining cancers are now the leading cause of mortality in patients living with HIV/AIDS, even those with normal CD4+ T cell counts [2].

CONCLUSIONS: Patients living with HIV/AIDS who develop non-AIDS defining cancers tend to present with more aggressive and advanced disease. Pulmonary involvement is common in metastatic melanoma, but presentation can be varied, ranging from pulmonary nodules, to mass lesions, obstructing endobronchial lesions or diffuse endobronchial melanosis [3].

Reference #1: Kubica AW et al. Melanoma in immunosuppressed patients. Mayo Clin Proc. 2012 Oct;87(10):991-1003.

Reference #2: Rubinstein PG et al. Malignancies in HIV/AIDS: from epidemiology to therapeutic challenges. AIDS. 2014 Feb 20;28(4):453-65.

Reference #3: Sutton FD Jr, et al. Varied presentations of metastatic pulmonary melanoma. Chest. 1974 Apr;65(4):415-9.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Lacy

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