Primary Esophageal Melanoma Research Articles

A Rare and Rapidly Progressive Case of Primary Esophageal Malignant Melanoma in an Elderly Patient

A Rare and Rapidly Progressive Case of Primary Esophageal Malignant Melanoma in an Elderly Patient

Endoscopic semiotics and pathological characteristics of primary malignant esophageal melanoma: a case report

Primary malignant melanoma of the esophagus is defined as a tumor, the frequency of which is 0.1-0.2% of all malignant lesions of the esophagus. This type of neoplasia is difficult to diagnose and is characterized by rapid progression, high recurrence rate and metastasis. Despite the diagnostic capabilities of X-ray examination methods, which make it possible to identify a tumor and determine its localization, the correct diagnosis can only be established by endoscopic examination of the upper digestive tract with biopsy and subsequent pathological and immunohistochemical studies. A 78 year-old male patient was admitted to the Herzen Moscow State Medical Institute with suspected esophageal cancer. It is known from the anamnesis, that the patient for 6 months notes a dysphagia, pain in the chest area. Based on the data of our expert endoscopic examination, we suspected primary esophageal melanoma with a mixed growth - exophytic and flat-type. According to the results of pathological examination of the biopsies, pigment epithelial-cell melanoma of the esophagus with high mitotic index (up to 3 mitosis figures per 1 sq.mm) with infiltrative growth type. This clinical case demonstrates the importance of a detailed endoscopic examination and performing a targeted biopsy, followed by expert pathological examination in the differential diagnosis of esophageal diseases characterized by pigmentation of mucosa.

Primary esophageal melanoma with a family history of esophageal cancer

A rare clinical observation of a 46-year-old patient with primary esophageal melanoma is presented. We demonstrate the difficulties of verifying the disease, taking into account the complex morphological picture of the tumor, anatomical features. The possibilities of modern combined treatment of this category of patients are also shown. For the first time, a case of primary esophageal melanoma with a family history of esophageal cancer is described.

Primary esophageal melanoma: features of diagnosis and treatment

Primary esophageal melanoma is a rare and extremely aggressive malignant neoplasm originating from mucosal melanocytes. The complex histological structure of the tumor, which in 10–25 % of cases may not contain melanin characteristic of these formations, leads to a high frequency of diagnostic errors, reaching 50 %. Immunohistochemical examination is the standard for diagnosing the disease. Primary esophageal melanoma is a tumor with a high potential for hematogenous and lymphogenous metastasis. So, when the tumor spreads to the submucosa, the frequency of locoregional metastasis reaches 54 %. Radical surgery in combination with adjuvant methods of treatment improves the results of treatment in this category of patients. Immunotherapy is a promising method of complex treatment, but requires further study.

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

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.

Primary esophageal malignant melanoma with severe liver injury of immune-related adverse events caused by nivolumab

Primary esophageal malignant melanoma with severe liver injury of immune-related adverse events caused by nivolumab

Clinical pathological features of 180 cases with primary esophageal malignant melanoma

Objective: To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma (PMME). Methods: The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected, of which 136 were male, aged (58.5±9.0) years, 44 were female, aged (56.7±12.2) years. Kaplan-Meier and Log rank test were used for survival analysis, Cox regression scale model was used for risk factor analysis. Results: The incidence of PMME is 0.036% (180/500, 000), mostly were male (about 3∶1 for men: female). The common sites of PMME were the lower part of the esophagus (48.9%, 85/174), followed by the middle section of the esophagus (46.0%, 80/174) and the upper part of the esophagus (5.2%, 9/174). No black particles were seen in the PMME cells of 3 patients under microscope, and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results. Of the 129 patients who had a routine preoperative esophageal biopsy, 69 were undiagnosed with PMME (53.5%). The medium survival time of the whole group was 7.9 months, and the survival rates of 1, 2, 3, 5 years were 25.0%, 7.9%, 6.6% and 1.3%, respectively. The univariate analysis showed that N, M, TNM phase and radiotherapy were related to the overall survival of patients (P<0.05). Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients (P<0.05). Conclusions: PMME is more common in men, the common site of the disease is the lower part of the esophagus. The preoperatively missed diagnosis rate of Chinese PMME is high. TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

Первичная меланома пищевода

Primary esophageal melanoma is an extremely rare malignancy with an estimated prevalence of 0.0036 cases per million per year. The prognosis of the disease is unfavorable, in 30-40% of patients metastases are detected at the time of diagnosis, generally accepted approaches to treatment are currently insufficiently developed. The article presents the review of the literature and describes the clinical case of a patient with primary esophageal melanoma

EP-1371: Primary oesophageal melanoma responds to hypofractionated radiotherapy

EP-1371: Primary oesophageal melanoma responds to hypofractionated radiotherapy

Primary Esophageal Melanoma

Primary Esophageal Melanoma

Primary Malignant Esophageal Melanoma in a 47-Year-Old Woman: A Case Report and Review of Literature

Introduction: Primary malignant esophageal melanoma makes up 0.1% to 0.2% of all esophageal malignancies. Most physicians assume malignant melanoma as a skin originated neoplasm, however this type of melanoma can occur anywhere in the gastrointestinal tract especially in the esophagus. Thus, it is essential to consider malignant melanoma in differential diagnosis of any esophagus masses. Case Presentation: In this study introduces a case of primary malignant esophageal melanoma and the method of investigation based on the patient’s complains. Then, evaluates the best method of treatment and assess prognosis and survival of our studied case. Macroscopic pathology findings include 5 × 3.5 cm tumor which was located in the one-third distal part of the esophagus. Moreover, pathology investigations reported melanoma tumor cells with melanin granules in squamous epithelium of esophagus with submucosal invasion. Discussion: In order to detect malignant melanoma as soon as possible, whole body examinations are required. Besides, the patient’s complaints are important as well. After malignancy exploration, selection of the most appropriate treatment is the ultimate goal. Education of health care providers reduces the burden of such malignancy for both patients and the health care system.

Endoscopic and Pathologic Findings Associated with Clinical Outcomes of Melanoma in the Upper Gastrointestinal Tract

Melanoma that involves the upper gastrointestinal (GI) tract is rare and studies relating to endoscopic and pathologic findings with clinical outcomes are lacking. We reviewed the gross and microscopic patterns of the upper GI tract in primary and metastatic melanoma, and examined their association with clinical outcomes. Twenty-nine cases of primary esophageal (n=19) and metastatic gastric and/or duodenal melanoma (n=10) that were detected during upper GI endoscopy between 1995 and 2011 were retrospectively analyzed. Three types of gross patterns were recognized-nodular pattern in 7 cases, mass-forming pattern in 18 cases, and flat pigmented pattern in 4 cases. In primary esophageal melanoma, 13 patients (68.4%) underwent surgery and 9 received palliative therapy. Of all cases, 22 patients (75.9%) died of disease progression; the median overall survival period was 12months (interquartile range [IQR] 4.5-24.5months), and from recognition of upper GI tract melanoma the median overall survival period was 9months (IQR 3.5-17.0months). In primary esophageal cases, skin melanoma stage better discriminated the patients with good prognosis than the esophageal cancer stage. The flat pigmented gross pattern proved to be a good prognostic factor in primary and metastatic GI tract melanomas (p=0.016 and p=0.046, respectively). Melanoma of the GI tract is a highly aggressive disease with a poor prognosis, both in primary and metastatic cases. However, in primary esophageal melanoma, careful inspection of the mucosa during endoscopic examination followed by surgical resection may result in extended survival.

Primary oesophageal melanoma - a case report

Primary upper gastrointestinal tract melanoma is a rare but well recognised entity, with a poor prognosis because of delay in diagnosis. Furthermore, it may be difficult to determine whether a gastrointestinal melanoma represents a metastasis or a primary tumour. We report a 67-year-old man with a primary oesophageal melanoma, treated with surgical resection, who remains disease-free two years post resection.

Metastatic Malignant Melanoma, Could it Hide a Primary Gut Culprit?

Background: Malignant Melanoma is one of the most common tumors to metastasize to the gastrointestinal (GI) tract from cutaneous primary source. Primary GI tract melanoma is rare and almost always reported as a solitary lesion. We are reporting a case of metastatic malignant melanoma with various areas of metastasis of unknown source. Case: A 55-year-old healthy man presented to our service for upper endoscopy with complaints of abdominal pain and weight loss. Upper endoscopy showed a 1.5 cm ulcerated nodule in the fundus with extrinsic impression. Colonoscopy showed 3-4 cm smooth ulcerated mass in the ascending colon (Figure 1). The patient had screening colonoscopy 5 years ago, which was normal. Biopsies came back with diagnosis of malignant melanoma on both gastric fundus and colonic masses. Further imaging showed bone, liver and pleural metastasis. No primary source was found on skin or ocular origin.FigureDiscussion: Primary GI tract melanomas are rare as most of GI melanomas are metastatic in origin. Primary gastric and colonic melanomas are rarely reported in the literature and almost always reported as solitary lesions without metastasis at time of diagnosis. Our patient presented with metastatic disease with no clear primary cutaneous or ocular source. The primary source could be previously regressed cutaneous melanoma or a primary GI (gastric or colonic) melanoma with secondary metastasis. Except for primary esophageal melanoma, no clear criteria have been suggested to differentiate a primary GI tract melanoma from a metastatic GI lesion. Conclusion: Further clinical and pathological studies are needed to differentiate primary versus metastatic GI melanomas in the absence of primary source. The ability to distinguish the two entities may change our current management.

Endoscopic submucosal dissection for primary malignant esophageal melanoma (with video)

A 70-year-old man with diabetes mellitus and a 5-month history of chronic kidney disease on peritoneal dialysis presented with 1 month of severe dysphagia. EGD revealed a large, polypoid, pedunculated, type “0-Ip” esophageal tumor, with black pigmented and red-colored areas. Easy movement of the tumor by retraction with the endoscopic forceps showed no apparent fixation to the muscularis propria (A). Biopsy specimens showed positivity for melanin staining. No primary cutaneous or ocular lesions were detected.

A Rare but Unique Tumor in the Esophagus

Question: A 72-year-old woman presented with progressive dysphagia and loss of 2 kg of body weight in 6 months. She denied heartburn or habitual consumption of cigarettes, alcohol, or betel quid. Physical examination and laboratory studies were normal. Esophagogastroduodenoscopy revealed several discrete, salmon-colored polypoid lesions (0.7–2.0 cm) in mid third of the esophagus (25–28 cm from the incisors; Figure A). Endoscopic ultrasonography showed that the smaller tumors only involved mucosa, but the larger ones invaded through muscular propria, (Figure B, arrow). What is the diagnosis of the esophageal lesion? Look on page 856 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. This woman had no risk factors for squamous cell carcinoma, the most common histologic type of cancer in the esophagus; the pathology report of the biopsy specimens was malignant melanoma. Repeat physical examination found no abnormal pigmentations of the skin or mucosa. Computed tomography and positron emission tomography revealed no distant metastasis, but did find a small, mediastinal lymph node with low grade of fluorodeoxyglucose uptake. She received thoracoscopic esophagectomy with gastric tube pull-up. Grossly, there were 6 polypoid tumors located from 0.75 to 2.5 cm near the proximal margin. The maximal size was 1.9 × 0.3 × 0.9 cm (Figure C). Pathology revealed junction activity composed of small, blue, round cells in the basal layer covered by squamous epithelium (Figure D). Immunostaining was positive for CD117, Melan-A, HMB45, and S100, and negative for cytokeratin and CD45. Muscularis mucosa was involved, but the resection margin and all the 22 lymph nodes were free of tumor invasion (pT1aN0M0). No adjuvant treatment was administered and she remained disease free after 7 months of follow-up. Primary esophageal melanoma is very rare, with an estimated frequency of 0.1%–0.2% of all esophageal cancers.1Bisceglia M. Perri F. Tucci A. et al.Primary malignant melanoma of the esophagus: a clinicopathologic study of a case with comprehensive literature review.Adv Anat Pathol. 2011; 18: 235-252Crossref PubMed Scopus (52) Google Scholar Most are grossly pigmented; the totally amelanotic variants consisted of 10%–25% of all the primary esophageal melanoma.1Bisceglia M. Perri F. Tucci A. et al.Primary malignant melanoma of the esophagus: a clinicopathologic study of a case with comprehensive literature review.Adv Anat Pathol. 2011; 18: 235-252Crossref PubMed Scopus (52) Google Scholar They may originate from melanocytes, which are normally present in the epitheliostromal junction of the esophagus in 7.7% of individuals.2Ohashi K. Kato Y. Kanno J. et al.Melanocytes and melanosis of the oesophagus in Japanese subjects: analysis of factors effecting their increase.Virchows Arch A Pathol Anat Histopathol. 1990; 417: 137-143Crossref PubMed Scopus (70) Google Scholar Without the typically dark appearance, amelanotic melanoma is more difficult to identify during endoscopic examination. The polypoid appearance provides a clue to the diagnosis. Primary esophageal melanoma is very aggressive and even tumors limited to within the mucosa carry the risk of distant metastasis years after complete resection. Radical esophagectomy with 3-field lymphadenectomy is the treatment of choice when feasible. The effectiveness of adjuvant chemotherapy, radiotherapy, and immunotherapy is controversial. The mean survival time after operation is 10–14 months.1Bisceglia M. Perri F. Tucci A. et al.Primary malignant melanoma of the esophagus: a clinicopathologic study of a case with comprehensive literature review.Adv Anat Pathol. 2011; 18: 235-252Crossref PubMed Scopus (52) Google Scholar

Primary malignant esophageal melanoma arising from localized benign melanocytosis

A heavy drinker and smoker had a normal UGI-endoscopy in 1996. In 1999, a repeat examination disclosed distal esophageal benign melanocytosis, typical, macro- and microscopically. Endoscopic and microscopic features were stable in 2002 and 2004. In 2007, dysphagia prompted an endoscopy, which disclosed a poorly differentiated epidermoid carcinoma at 19 cm and black nodules of the cardia with a microscopy typical of malignant melanoma, uT3N1 at EUS. Radiochemotherapy led to an 8-month improvement, which did not prevent death one year after diagnosis.

Bilateral Choroidal Metastases from Primary Esophageal Melanoma

The purpose of this case report is to report a rare, bilateral, choroidal metastases from a primary esophageal melanoma. A 44-year-old white female presented to the ocular oncology clinic in February 2010 on urgent referral from her ophthalmologist for evaluation of an elevated mass in each eye. The patient presented with best-corrected visual acuities of 20/25 in both eyes. Fundus examination displayed creamy white choroidal infiltrates located in the superior temporal arcade of the right eye and temporally in the left eye. The patient was diagnosed with bilateral choroidal metastatic melanoma from known primary esophageal melanoma. External beam radiation therapy was administered and complete resolution of the lesions occurred. Final visual outcome was 20/20 in both eyes. Nine months after diagnosis of choroidal metastases, the patient died from complications related to the extensive systemic metastatic involvement. Choroidal metastases are the most common intraocular malignancy. However, metastatic melanoma is a rare finding and has only been reported from cutaneous and primary choroidal melanoma. Therefore, to the best of the authors' knowledge, this is the first reported case of bilateral choroidal metastasis from a primary esophageal malignant melanoma.

Plasmacytoid Melanoma of the Urinary Bladder and Lymph Nodes with Immunohistochemical Expression of Plasma Cell Markers Revealing Primary Esophageal Melanoma

Plasmacytoid variant of melanoma is reported in only rare cases. We present the case of a 54-years-old man admitted for enlarged lymph nodes in the lumbar region. Initial diagnosis of plasmablastic lymphoma/plasma cell myeloma was considered. At our institute, a bladder polyp was removed. Microscopic exam demonstrated dense plasmacytoid cells infiltration with pigment deposits. Immunohistochemical study showed strong expression of HMB45, Melan A, and vimentin. There was focal positivity with S100 protein and CD138/syndecan-1. The diagnosis of metastatic plasmacytoid melanoma was finally established. Clinical exam revealed an esophageal melanoma with melanosis supporting its primary location. Although rarely, melanoma especially plasmacytoid variant may express plasma cell markers which may lead to erroneous diagnosis of plasma cell proliferation. Careful morphological examination for melanin pigment and the use of panel of melanocytic markers are helpful for diagnosis.

Melanocytosis of the oesophagus: case report

Esophageal melanocytosis is a benign clinicopathologic entity characterized by melanocytic proliferation in esophageal squamous epithelium and melanin deposition in the mucosa. Little is known about the etiology and natural course of this condition, although it has been suggested to be a precursor of primary esophageal melanoma by some authors. Following a search of the databases regarding esophageal melanocytosis and melanosis, thirty-four cases of isolated esophageal melanocytosis were found. The histopathologic features of esophageal melanocytosis are reviewed and its differential diagnosis with other pigmented esophageal lesions is discussed.