Keywords
Melanoma, Esophagus
Α 70 year old female was admitted to our hospital with a history of dysphagia for solids and weight loss. An endoscopy was performed and revealed an ulcerated mass involving the lower third of esophagus (Figure 1). Histology revealed a diffuse proliferation of atypical epithelioid amelanotic cells with irregular nuclear borders and sometimes prominent nucleoli associated with tumor necrosis. Immunohistochemical findings included positive Melan-A, SOX-10, HMB-45, focally positive S-100 and negative CK20, CK7, Synaptophysin, TTF-1, LCA and CD-117 (Figure 2). Positron emission tomography-CT (PET-CT) showed an increased uptake of fluorodeoxy-glucose in the lower part of esophagus (Figure 3). After a thorough search for a primary tumor from skin, ocular and mucosal sites a diagnosis of primary malignant melanoma of esophagus (PMME) was made. A subtotal esophagectomy was done, the patient had a good clinical outcome and was discharged 10 days after surgery.
Primary malignant melanoma of the esophagus (PMME) accounts for 0.1–0.2% of all primary neoplasms of the esophagus1. Most commonly, it affects patients between the sixth and seventh decade of life and there is a male predominance2. Most common symptoms are dysphagia, chest pain, and weight loss. PMME is usually fatal with a mean survival time 13.4 months3.