Hearing loss, why bronchial tree may be involved?

A 62-years-old man former occasional smoker was hospitalized for progressive hearing loss and Magnetic Resonance Imaging (MRI) detected multiple round hyperdense lesions in each cerebral hemisphere. Total body Computed Tomography (CT) scan showed a lobulated consolidative lesion on the right lung lower lobe associated to conglomerate lymph nodes (11R) suspected for primary lung cancer. Endoscopy showed an endobronchial invasion and integrated endobronchial ultrasound did not demonstrate any accessible lymph node for sampling. Forceps biopsy report on the endobronchial specimen led to histopathological diagnosis of metastatic melanoma. Skin and ophthalmologic examinations were negative for suspicious pigmented lesions findings and patient had no history of familiarity for melanoma. Malignant melanoma is rarely observed to metastasize to endobronchial tissue and it is represented only in the 4.5% of cases. The vast majority of endobronchial metastases are metachronous, even after several years. Nevertheless, the anachronous manifestations are possible.