Primary Malignant Melanoma of the Esophagus Presenting with Massive Hematemesis

Abstract

A 66-year-old Japanese man was admitted to our hospital, presenting with massive hematemesis. Emergency endoscopy revealed a bleeding tumor at the esophagogastric junction. The endoscopic appearance of the tumor was that of a Borrmann 2-like tumor, with a brownish-black discoloration. Bioptic histology confirmed the diagnosis of malignant melanoma. Atypical melanocytes with junctional changes were also found at a small pigmented patch in the lower esophagus, separate from the gross tumor. Melanocytosis was noted in the adjacent esophageal epithelium in the resection specimen following surgery. No primary lesion was found elsewhere, even in the patient's skin. These pathologic findings support the possibility of multicentric occurrence of malignant melanoma in esophageal melanocytosis. The patient is alive 11 months later, with multiple liver metastases. Massive hematemesis is an unusual presentation of primary malignant melanoma of the esophagus.

Primary Malignant Melanoma of the Esophagus

“…Melena, due to bleeding from the tumor is another complaint sometimed reported (7% in the review of Sabanathan et al), 4 and there are also 2 cases presenting with hypovolemic shock due to severe bleeding, one with massive melena and the other with hematemesis. 31,101 Grossly the tumors are most often polypoid and ulcerated, and can vary in size from small lesions to large, bulky sessile masses, whereas only a minority present as plaque-like tumors or as diffuse thickened, almost con-centric, stricture-like lesions (Table 1). Occasionally, polypoid tumors are pedunculated, 26,27,46 with a stalk of variable thickness.…”

Endoscopic Ultrasonography–Guided Fine Needle Aspiration Biopsy for Staging Malignant Melanoma of the Esophagus

“…The presenting symptoms, in particular the lack of dysphagia, deviated from the classical pattern. 32 The diagnosis was established on the endoscopic biopsy. Similar preoperative diagnostic success on endoscopically obtained biopsy material has been obtained in 50% of cases.…”

Primary Gastric Melanoma with Rhabdoid Features: A Case Report

“…Rare cases of gastrointestinal melanosis, with or without melanosis cutis, have been reported. For example, esophageal melanocytosis is characterized by nontumoral intraepithelial melanocytes with increased melanin pigmentation 9. Therefore, it is possible that primary gastric melanoma may infrequently occur from these rare precursor lesions.…”