J Korean Med Sci.  2007 Feb;22(1):149-152. 10.3346/jkms.2007.22.1.149.

Surgical Treatment of Primary Malignant Melanoma of the Esophagus: A Case Report

• Lee SA
• Hwang JJ
• Choi YH

• KMID: 1713256
• DOI: http://doi.org/10.3346/jkms.2007.22.1.149

Abstract

Primary malignant melanoma of the esophagus (PMME) is an extremely rare tumor with only scattered cases reported. Although surgical resection has been considered as the best possible option, the prognosis has been nonetheless poor. We report a case of PMME which was treated by surgical resection and additionally followed by chemotherapy. A 60-yr-old man underwent an esophagoscopy due to a 3-month history of dysphagia and upper abdominal discomfort. A pigmented polypoid mass in the lower third of the esophagus was discovered, and a biopsy identified the mass as a malignant melanoma. Consequently, a subtotal esophagectomy and intrathoracic esophagogastrostomy was carried out. At follow-up four months after discharge, lymph node enlargements in the cervical area and celiac axis area were found. As a result, the patients was started on systemic chemotherapy treatment, which included Dacarbazine. The patient has been doing well and is now 35 months post-operative.

Keyword

Esophageal Neoplasms; Melanoma; Esophagectomy

MeSH Terms

Middle Aged
Melanoma/pathology/*surgery
Male
Humans
Esophageal Neoplasms/pathology/*surgery

Figure

• 

  Fig. 1 Pre-operative esophagogram demonstrating a 4 cm sized mass with an irregular surface protruding into the lower esophagus.

• 

  Fig. 2 Contrast-enhanced chest CT scan showing a mass lesion from posterior wall of the lower esophagus (arrow).

• 

  Fig. 3 Abdominal CT scan showing lymphadenopathy in the lesser curvature of the stomach (arrow).

• 

  Fig. 4 Gross appearance of the resected specimen showing the ulcerated, black, sessile polypoid tumor in the lower esophagus with lymph node enlargement along the lesser curvature of the stomach (arrow).

• 

  Fig. 5 Photomicrograph of the tumor showing junctional activities of atypical melanocytes around base of the tumor (H&E, ×100).

• 

  Fig. 6 Photomicrograph of the tumor revealing pigmented and non-pigmented malignant melanoma cells with vesicular nuclei, prominent nucleoli, and moderate amount of pale eosinophilic cytoplasm (H&E, ×200).

Reference

1. Turnbull AD, Rosen P, Goodner JT, Beattie EJ. Primary malignant tumors of the esophagus other than typical epidermoid carcinoma. Ann Thorac Surg. 1973. 15:463–473.

2. Chalkiadakis G, Wihlm JM, Morand G, Weill-Bousson M, Witz JP. Primary malignant melanoma of the esophagus. Ann Thorac Surg. 1985. 39:472–475.

3. Allen AC, Spitz S. Malignant melanoma: A clinico-pathological analysis of criteria for diagnosis and prognosis. Cancer. 1953. 6:1–45.

4. Stranks GJ, Mathai JT, Rowe-Jones DC. Primary malignant melanoma of the esophagus: case report and review of surgical pathology. Gut. 1991. 32:828–830.

5. DiCostanzo DP, Urmacher C. Primary malignant melanoma of the esophagus. Am J Surg Pathol. 1987. 11:46–52.

6. Hamdy FC, Smith JH, Kennedy A, Thorpe JA. Long survival after excision of a primary malignant melanoma of the oesophagus. Thorax. 1991. 46:397–398.

7. Caldwell CB, Bains MS, Burt M. Unusual malignant neoplasms of the esophagus. Oat cell carcinoma, melanoma, and sarcoma. J Thorac Cardiovasc Surg. 1991. 101:100–107.

8. Joob AW, Haines GK III, Kies MS, Shields TW. Primary nalignant melanoma of the esophagus. Ann Thorac Surg. 1995. 60:217–222.

9. Suzuki Y, Aoyama N, Minamide J, Takata K, Ogata T. Amelanotic malignant melanoma of the esophagus: report of a patient with recurrence successfully treated with chemoendocrine therapy. Int J Clin Oncol. 2005. 10:204–207.

10. Matsutani T, Onda M, Miyashita M, Hagiwara N, Akiya Y, Takubo K, Yamashita K, Sasajima K. Primary malignant melanoma of the esophagus treated by esophagectomy and systemic chemotherapy. Dis Esophagus. 2001. 14:241–244.