Primary Malignant Melanoma of the Esophagus: A Case Report and Review of the Literature

Abstract

Patient: Male, 67Final Diagnosis: Primary malignant melanoma of esophagusSymptoms: DysphagiaMedication: —Clinical Procedure: Endoscopic biopsySpecialty: Gastroenterology and HepatologyObjective:Challenging differential diagnosisBackground:Primary malignant melanoma of the esophagus (PMME) is a rare cancer with a poor prognosis. It is often difficult to differentiate from non-epithelial malignant tumors, and immunohistochemical staining may be needed to diagnose the condition. The mainstay of treatment is usually surgical with curative or palliative intent, since radio- and chemotherapy do not really improve the outcome. The average survival rate after surgery is 34.5 months. At the time of diagnosis, 40–80% of cases have local regional lymph node metastases.Case Report:The case of a 67-year-old male patient with PMME is reported. He presented with progressive dysphagia. A computerized tomography was performed in which a polypoid mass was observed in the distal esophagus. It was originally suspected to be an adenocarcinoma, but was subsequently correctly diagnosed by immunohistochemical staining with HMB-45 antibody and by the presence of S-100 protein. A subtotal esophagectomy was performed.Conclusions:Very few cases of PMME have been reported in the literature and there is only limited clinical experience with this disease. Therefore, it is very difficult to establish clear criteria for clinical recognition of this type of melanoma. Early histopathological confirmation of the character is essential for further treatment in case of confirmation of malignancy.

Characteristics and Surgical Outcomes for Primary Malignant Melanoma of the Esophagus

“…The diagnosis of PMME for our patients was made depending upon post-operative pathological examination with immunohistochemical checkup. The majority of the specimens had positive expression of the classic immunomarkers, like MB-45, Melan-A, S100, and vimetin, which is consistent with other reports 6 10 15 16 . However, accurate diagnosis before surgery is difficult even with endoscopic biopsy.…”

Superficial Primary Malignant Melanoma of the Esophagus Detected and Treated at Stage 0

“…In addition, although biopsy of malignant melanoma is conventionally not considered to be indicated, there have been no reports of metastasis or dissemination after biopsy, and it has been reported that the presence or absence of biopsy has no effect on the prognosis (3). Therefore, in order to obtain a definitive diagnosis, many reports suggest that a biopsy should be performed when a suspicious lesion is detected by endoscopy (12)(13)(14)(15).…”