UNUSUAL CASE OF SUPERIOR VENA CAVA SYNDROME

TOPIC: Disorders of the Mediastinum TYPE: Global Case Reports INTRODUCTION: Malignant melanomas account for 1.7% all cancers. Primary malignant melanoma involving mediastinum is very rare, and has only been documented in few case reports (1-4). We describe a mediastinal primary presenting as superior vena cava (SVC) syndrome CASE PRESENTATION: A 74-year-old woman with medical history hypertension, presented to our emergency department weight loss past 6 months recent facial edema. She ruled out changes her voice, dyspnea, fever or night sweats. Patient had 30-pack-year smoking. Her physical examination revealed edema no signs distress. CT scan (figure 1) showed 4.6 cm X 5.4 12 heterogenous right mass, invading SVC lumen atrium. Lymphadenopathy 2R, 4R, 7 10R stations. Two lung masses: 3.1 x 3.2 3.5 middle lobe 2.7 left upper lobe, were noted. Bronchoscopy was performed transbronchial needle aspiration from both mass sub-carinal lymph node taken. Histologic diagnosis 2) melanoma, confirmed by positive stain SOX-10. BRAF negative. The not surgically resected due its location vascular invasion. Examination dermatologist an ophthalmologist evidence skin eye lesion. patient received combined chemo radiation therapy. DISCUSSION: without extra-thoracic disease extremely rare cases reported (1,4). These tumors can be metastatic cutaneous lesion that regressed, also de novo melanomas. To date, three obstruction secondary have literature (5-6). One treated inhibitor (7), another chemotherapy radiotherapy (6), while third endovascular stenting (5). prognosis, management unknown rarity. suggest aggressive clinical course. Radiotherapy usually first line treatment, dministered control local spread tumor, particularly if tumor amenable surgery. CONCLUSIONS: This mass. Only previously published literature. Our being currently adjuvant chemotherapy, therapy, since surgical resection, absence mutation. REFERENCE #1: Karuppiah SV, Buchan KG. melanoma: cause Jpn J Thorac Cardiovasc Surg 2006;54:396-398. #2: Lau CL, Bentley RC, Gockerman JP, Que LG, D'Amico TA. Ann 1999;67:851-852. #3: Pandya B, Ramraje S, Darade A. mediastinum. Assoc Physicians India 2004;52:924- 925 DISCLOSURES: No relevant relationships Hanna Dawood, source=Web Response disclosure on file Ludmila Guralnik; Inna Naroditsky; Anna Solomonov; Elit Vainer Evgrafov; Yaniv Zohar,