Korean J Gastroenterol.  2022 May;79(5):222-227. 10.4166/kjg.2022.031.

Primary Esophageal Malignant Melanoma in Korea: Clinical features, Management and Prognosis

• Oh HH
• Jung YW
• Han B
• Im CM
• Yu HJ
• Joo YE

• KMID: 2530330
• DOI: http://doi.org/10.4166/kjg.2022.031

Abstract

Primary esophageal melanoma is a rare disease with a poor prognosis. To date, 18 cases have been reported in Korea. Four patients visited the Chonnam National University Hwasun Hospital with dysphagia, followed by epigastric pain and discomfort, odynophagia, and weight loss. Esophagogastroduodenoscopy revealed a black pigmented polypoid mass, protruding mass, or black-pigmented flat lesions. Two patients had distant metastases and lymphadenopathies in imaging studies. Two patients underwent esophagectomy and intrathoracic esophagogastrostomy. One patient was treated with chemotherapy and interferon-alpha. The other patient declined further treatment. The routine histology using H&E revealed brown-colored atypical melanocytes. Immunohistochemical staining exhibited strong reactivity for Melan-A, S-100, and HMB-45 proteins. The biopsy specimens were interpreted to be malignant melanoma. One patient had multiple distant metastases 13 months after surgery. The other patient had no recurrence for 33 months after surgery. The patient treated with chemotherapy and interferon-alpha showed disease progression in the follow-up examination. Primary esophageal melanoma in Korea is a rare disease characterized by aggressive behavior, early metastasis, and poor prognosis.

Keyword

Melanoma; Esophagus; Korea

Figure

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  Fig. 1 Endoscopic findings show a black pigmented polypoid mass.

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  Fig. 2 Chest computed tomography shows the eccentric irregular wall thickening and enhancement in (A) the mid-esophagus (arrow) and multiple necrotizing lymphadenopathies at (B) the carina (arrow).

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  Fig. 3 Pathological findings. (A) In the endoscopic biopsy specimens, brown-colored atypical melanocytes are observed (arrows) (hematoxylin and eosin stain [H&E], ×200). Immunohistochemical staining is positive for (B) Melan A (×200), (C) S-100 (×200), and (D) HMB45 (×200) proteins.

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  Fig. 4 Endoscopy findings show (A) a protruding mass without black pigmentation, and black pigmented and (B) flat lesion in the esophagus.

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