A Case of Primary Malignant Melanoma of the Esophagus

Abstract

Primary malignant melanoma of the esophagus is a rare disease and aggressive tumor of the esophagus. Primary malignant melanoma represents 0.1% to 0.2% of all primary esophageal cancers. Hematogenous and lymphatic metastasis are common. The prognosis is quiet poor, so early dectection and accurate diagnosis should be made. We encountered a patient with a black esophageal lesion, which was histopathologically confirmed to be primary malignant melanoma of the esophagus. A 65-year-old men was admitted for evaluation of a black pigmentation at lower esophagus which was found at regular general physical exam. He had no symptoms, no history of any illness and no family history of cancer. Physical examination found no abnormal pigmentations of the skin or mucosa. Endoscopy revealed multiple scattered 0.4cm sized black pigmented ulcerative lesion at 37cm from the incisors (Figure 1). Pathological findings from endoscopy show melanin pigment deposition and melanophage infiltration (Figure 2). Immunohistochemical staining was positive for HMB45, Ki-67, S100 and melan-A. Computed tomography of chest and abdomen showed no evidence of discernible lesion in the stomach, lung and regional lymphadenopathy. Positron emission tomography demonstrated no regional or distant metastasis. He received esophagectomy and gastroesphagostomy. Muscularis mucosa was involved, but the surgical margin of the esophagus was free from tumors. And all regional lymph nodes were found free of tumor.Figure 1Figure 2