Ground-glass nodules found in two patients with malignant melanomas: different growth rate and different histology
Introduction
When we found ground-glass nodules during the interpretation of chest computed tomography (CT) in patients with melanoma, the differentiation between metastasis and primary pulmonary lesions such as atypical adenomatous hyperplasia (AAH) or bronchioloalveolar carcinoma (BAC) could be difficult. In this report, we presented two pathologically proven pure ground-glass nodules found in two patients with malignant melanoma. From the experience of these two cases, the important information for differential diagnosis could be provided.
Section snippets
Case 1
In August 2007, a 70-year-old man visited our hospital for skin discoloration localized to the left fifth toe. The lesion was diagnosed as malignant melanoma, and the patient underwent ray amputation of the affected digit. To evaluate the possibility of distant metastasis, we performed chest CT, and a 10-mm-sized pure ground-glass nodule was visualized in the right upper lobe (Fig. 1A). Probable radiologic diagnoses included metastatic melanoma, AAH, BAC, adenocarcinoma with BAC component, and
Discussion
Ground-glass nodule or nonsolid nodule is the nodule with hazy increased attenuation that does not obliterate the bronchial and vascular margins. The majority of ground-glass nodules has been proven to be AAH, BAC, adenocarcinoma with BAC components, eosinophilic pneumonia, endometriosis, focal interstitial fibrosis with organizing pneumonia, or traumatic lung lesions [1], [2].
Some articles have described the histological findings of ground-glass nodules found in extrapulmonary malignancies.
Conclusion
We describe ground-glass nodules found in two patients with malignant melanoma that differed histologically. One nodule showed no growth and proven to be BAC, whereas the other grew rapidly over a few 3 months and was histologically proven to be metastatic melanoma. Based on the evidence presented here, we advise when the chest CT scans of melanoma patients are interpreted that rapidly growing ground-glass nodules be suspected as metastases and that slow or zero growth lesions be considered
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- 1
Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea