CRA64 PRIMARY MALIGNANT PLEURA MELANOMA: CASE REPORT

Firdaus M, Lam YF, Ranjitha, Puteri Saerah, Jarret Raj, Noor Assyikin, Nur Najihah, Rekha S

Department of Respiratory, Hospital Raja Pemaisuri Bainun, Ipoh, Malaysia

INTRODUCTION
Malignant melanoma, a cancer by melanocytes that predominantly affects the skin. Uncommonly it can develop in ocular, mucosal, and, also urethral tissues. Primary pleural melanoma is an exceedingly rare occurrence, with only a handful of cases reported globally. This case details an unusual case of primary malignant melanoma of the pleura in a 38-year-old male patient. Informed consent was obtained for this publication.

CASE REPORT
A case of possible primary malignant melanoma in the lung of a young 38 year-old Malay male is reported. The patient presented with symptoms of cough, breathlessness and constitutional symptoms. The chest Xray noted opacity  and patient was treated as pulmonary tuberculosis empirically. Progression lead to pleuroscopy findings with a positive HPE melanoma. Skin examination and a biopsy showed no skin melanoma.  A primary tumour is suspected given the presentation and imaging. Patient was treated with chemotherapy and immunotherapy but succumb.

RESULTS
Pleural biopsy: fibrous tissue infiltrated by malignant cells arranged in sheets and irregular clusters associated with areas of crushed artifacts. The malignant cells exhibit round to oval, and spindle shaped hyperchromatic to vesicular nuclei, some with prominent nucleoli and eosinophilic to clear cytoplasm. Extensive melanin pigments noted positive for masson fontana.

CONCLUSION
Primary pleura melanoma represents a rare entity. Diagnosis in regions which is common for tuberculosis is challenging. Thorough history and clinical assessment with positive histopathological findings is important in diagnosis and ruling out other diagnosis. Early imaging and skin exploration is important to rule out metastasis. Due to the small number of cases reported in the literature, there is little experience on the management and the prognosis of the disease.