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Update Mel right lung Histopathology Report

Forums General Melanoma Community Update Mel right lung Histopathology Report

  • Post
    Wally
    Participant

      Hi all, Wally from Johannesburg South Africa here. I previously posted in May 2011 and had some very pleasing replies.

      Hi all, Wally from Johannesburg South Africa here. I previously posted in May 2011 and had some very pleasing replies.

      I have eventually obtained a Histopathology following upon the resection of the right middle lobe of the right lung. You may recall that about 5 years ago I had a resection of a malignant melanoma in-situ from my right ear. Final Histology report stated up to 1 mitosis / mm2 could be seen. Breslow 0 Clarke Level 1. No ulceration. Solar elastosis of collagen noted in upper part of dermis. Surgical margins free from the lesion with a radical perimeter of 5mm and a vertical perimeter of 8mm.

      Macros copy of lung resection:

      1. Medial segment middle lobe – stapled pulmonary wedge resection 40X30X30mm (18 grams), in which there is a fleshy greyish-white tumour, 20mm in diameter as per macro photograph fig 1.
      2. Lateral segment, middle lobe – pulmonary wedge resection 80X30X10mm (14 grams), with an area of HAEMMORHAGE/QUERY HAMEORRHAGIC INFARCTION measuring 30X10mm as per macro photograph fig 2.

      Microscopy:

      Representative sections of the MEDIAL SEGMENT/MIDDLE LOBE/SPECIMAN 1 shows pulmonary parenchyma in which the presence of a METASTATIC PLEOMORPHIC PIGMENTED EPITHELIOID TUMOUR is present, within an intrapulmonary lymph node.

      This tumour has features consistent with those of a METASTATIC MALIGNANT MELANOMA.

      Representative sections of LATERAL SEGMENT OF THE MIDDLE LOBE/SPECIMEN 2 show an area of recent pleural intrapulmonary haemorrhage.

      There is, within this tissue, desquamated bronchial epithelium, which shows the appearance of a “pseudo tumour”.

      Comment:

      Appropriate immunohistochemical confirmation of the SUSPECTED METASTATIC MALIGNANT MELANOMA will follow. HMB45/Mel A marker.

      ICD-10 Coding                    C34.9

      Diagnosis:

      SPECIMEN 1, LOBE OF LUNG, MEDIAL SEGMENT:

      1. FEATURE CONSISTENT WITH METASTATICMALIGNANT MELANOMA.
      2. SEE ABOVE COMMENT.

      SPECIMAN 2, MIDDLE LOBE, LATERAL SEGMENT:

      RECENT INTRAPULMONARY HAEMMORHAGE.  (What does this mean?)

      IMMUNOHISTOCHEMISTRY

      1. Mel A (marker for melanocytes – very strongly positive.
      2. HMB45 – marker for melanocytes – very strongly positive.

      Comment:

      The above immunohistochemical profile supports the morphological diagnosis of a METASTATIC MALIGNANT MELANOMA.

      This is all very confusing to me as I have never been exposed to this medical terminology before. I am not sure of how serious my situation is and find no case history on the Bulletin Board similar to mine.

      I guess the bottom line is:

      Is it evident from the report that all traces of the Melanoma have been removed and all necessary tests done to ensure that no Sentinel Nymph Nodes evidence signs of cancer or have been biopsied (as I have read in previous posts)

      How great are the chances of a recurrence somewhere else in my body – can one tell?

      The Oncology Radiologist suggested a wait and monitor strategy with a chest X-ray every 3 months and a blood test. Is this sufficient to establish that it is not spreading or should I insist on a PET / CT scan?

      No treatment at this stage was recommended (I presume that is unless the follow-up visits evidence a recurrence, I was not told so though.)

      I would appreciate any guidelines, input or thoughts please as I remain anxious and need to get perspective as to how to deal with this going forward. I try getting my mind off this but continue finding my mind wrestling with “what ifs” – especially at night when trying to sleep.

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    • Replies
        lhaley
        Participant

          Wally,

          I am going to be making some assumptions here. I am assuming that this lung tumor came from your original insitu primary. It does happen but not often. You could also have an unknown primary. Either case, it is what it is, and now you have to make sure and get the proper follow up.

          Not sure if you have been staged. I am assuming you are stage IV since it's now been in your lungs. I would request a PET/CT. X rays are just not diagnostic enough to see if it has spread elsewhere. Also, blood work isn't going to show anything melanoma wise except to show your general health. While not a bad idea, it's also not going to be diagnostic.  There is one blood test that is used by some Doctors but it doesn't actually show if there are melanoma cells like other cancers do.  Some have their ldh tested but I believe that shows kidney or liver function (not sure which) and it is for those with disease in that area.

          If the lung tumor was the only one then you probably are on a wait and watch regime. I've been there many times. There are very few options for Stage IV when NED (no evidence of disease).  A few trials out there but you need to have a specific hla blood factor. These are things you need to find out . Is there a trial available in South Africa?   Is the Dr that is treating you knowledgable in melanoma? 

          In the meantime while you wait. Ask your Dr to have the tumor they removed tested for the different mutations (might want to make sure that your insurance will pay) and have your blood tested for the hla 0201 negative factor.

          The last thing is if your not sleeping, ask for a sleep aid. Nights are the worse when melanoma is threatening.

          Linda

          Stage IV since 06  Currently 3 weeks NED  6 recurrances Radiation starting on Monday

          It's hard to do watch and wait but after a bit you do realize that quality of life is important. I've been doing that since July 06. During that time I have had many surgeries but continue to live and enjoy.

          One other thought. If you can't get to see a specialist in melanoma due to your location, you can often find Drs who will do a remote second opinion. They reread all slides and scans. Then they write out a plan for the future tests. When I was originally diagnosed my insurance company suggested that.

          lhaley
          Participant

            Wally,

            I am going to be making some assumptions here. I am assuming that this lung tumor came from your original insitu primary. It does happen but not often. You could also have an unknown primary. Either case, it is what it is, and now you have to make sure and get the proper follow up.

            Not sure if you have been staged. I am assuming you are stage IV since it's now been in your lungs. I would request a PET/CT. X rays are just not diagnostic enough to see if it has spread elsewhere. Also, blood work isn't going to show anything melanoma wise except to show your general health. While not a bad idea, it's also not going to be diagnostic.  There is one blood test that is used by some Doctors but it doesn't actually show if there are melanoma cells like other cancers do.  Some have their ldh tested but I believe that shows kidney or liver function (not sure which) and it is for those with disease in that area.

            If the lung tumor was the only one then you probably are on a wait and watch regime. I've been there many times. There are very few options for Stage IV when NED (no evidence of disease).  A few trials out there but you need to have a specific hla blood factor. These are things you need to find out . Is there a trial available in South Africa?   Is the Dr that is treating you knowledgable in melanoma? 

            In the meantime while you wait. Ask your Dr to have the tumor they removed tested for the different mutations (might want to make sure that your insurance will pay) and have your blood tested for the hla 0201 negative factor.

            The last thing is if your not sleeping, ask for a sleep aid. Nights are the worse when melanoma is threatening.

            Linda

            Stage IV since 06  Currently 3 weeks NED  6 recurrances Radiation starting on Monday

            It's hard to do watch and wait but after a bit you do realize that quality of life is important. I've been doing that since July 06. During that time I have had many surgeries but continue to live and enjoy.

            One other thought. If you can't get to see a specialist in melanoma due to your location, you can often find Drs who will do a remote second opinion. They reread all slides and scans. Then they write out a plan for the future tests. When I was originally diagnosed my insurance company suggested that.

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