Background: Malignant melanoma (MM) has the potential to spread to virtually any organ. We reported a case of MM presenting as hemoptysis, with two suspicious primary foci, lung and gallbladder, confirmed by histology.
Case Presentation: A 56 year-old female smoker presented with productive cough and hemoptysis for half a year. She denied any dyspnea, fever, malaise, abdominal discomfort, and any personal history of lung or gastrointestinal disease. Chest film disclosed patchy opacity over right lower lung. Thorough physical examination of all skin surfaces, including her oral mucosa, was negative. The patient underwent the right lower lung lobectomy without complication, and a black, firm MM measured 4.7x 4.5x4 cm was found. For searching other possible primary or metastatic site, PET-CT was performed and showed F-18 FDG avid lesions in the gallbladder. Partial hepatectomy and cholecystectomy were done and revealed one black, fragile and polypoid tumor measuring 9.0x4.0x3.4 cm. Both specimens were proved of MM.
Discussion: The pathologic diagnosis of MM in tumors from lung and gallbladder is confirmed by immunochemical study of S-100 and HMB-45. The imaging study of endoscopic ultrasound, computed tomography, and MRI was reported. Surgical therapy should be performed aggressively for complete removal. PET-CT plays a crucial role in detecting asymptomatic MM in gallbladder for this patient, and certainly help for more accurate patient selection for surgical excision. A series of image studies, including CT, MRI, endoscopic ultrasound, and abdominal ultrasound will be presented. After review of the literature, surgical resection is mandatory for improve survival in limited metastatic melanoma.