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.