Simultaneous resection of metastatic melanoma in the esophagus and primary cutaneous melanoma showing partial regression: report of a case

We herein describe a case of melanoma that metastasized to the esophagus from a primary melanoma of the abdominal skin in a 40-year-old female. Esophagography and endoscopy demonstrated a 30-mm protruding mass in the proximal third of the esophagus, and this was diagnosed as malignant melanoma by mucosal biopsy. The patient also had a pigmented lesion on her abdominal skin, which was diagnosed immunohistochemically as a primary malignant melanoma from the resected specimen. The esophageal tumor was resected by transthoracic esophagectomy. Histopathologically, the radial growth phase of the tumor cells was not present in the esophageal lesion, which was diagnosed as melanoma metastatic to the esophagus. Postoperatively, the patient received 5 courses of DAV-Feron chemotherapy. Eight months after the chemotherapy, multiple metastases developed, including to the subcutis, bronchus, liver, adrenal gland and mediastinum. Chemotherapy was not effective at this stage. The patient died of multiple organ failure 21 months after initial esophagectomy.     

Endoscopic Nd:YAG laser and radiation therapy for primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is rare. Reports on approximately 112 cases have appeared in the world literature. We report the 113th case in the eldest known patient at the time of diagnosis. Endoscopic neodymium-yttrium-aluminum-garnet laser coagulation, in conjunction with radiation therapy, was performed. This nonsurgical treatment combination appears to provide adequate palliative therapy for primary malignant melanoma of the esophagus.     

Malignant melanoma metastatic to the esophagus

A rare case of metastatic malignant melanoma of the esophagus 11 years after wide excision of a cutaneous malignant melanoma is presented and the relevant literature reviewed. Symptomatic esophageal metastasis is unusual in malignant melanoma. Although the eventual outlook is poor in such cases, worthwhile palliation can be achieved by prompt diagnosis and treatment.     

Primary malignant melanoma of the esophagus —A case report—

An unusual case of primary esophageal melanoma is reported herein. A 68 year old man who had experienced occasional dysphagia for about one month without suffering any weight loss was admitted to our department. An esophagogram revealed two lobulated masses and esophagoscopy showed a pigmented tumor in one of the masses. Curative surgery was thus performed through a right thoracotomy. The macroscopic appearance of the resected specimen was very unusual and it was subsequently proven to be primary malignant melanoma of the esophagus by histological examination. Postoperatively, cyclophosphamide and interleukin-2 were administered intravenously, followed by lymphokine-activated killer therapy. However, multiple liver metastases were found on a CT scan, 3 months after the operation and the died about 1 month later. The operative indications for primary malignant melanoma of the esophagus are discussed in this report.     

Primary malignant melanoma of the esophagus--a case report

An unusual case of primary esophageal melanoma is reported herein. A 68 year old man who had experienced occasional dysphagia for about one month without suffering any weight loss was admitted to our department. An esophagogram revealed two lobulated masses and esophagoscopy showed a pigmented tumor in one of the masses. Curative surgery was thus performed through a right thoracotomy. The macroscopic appearance of the resected specimen was very unusual and it was subsequently proven to be primary malignant melanoma of the esophagus by histological examination. Postoperatively, cyclophosphamide and interleukin-2 were administered intravenously, followed by lymphokine-activated killer therapy. However, multiple liver metastases were found on a CT scan, 3 months after the operation and he died about 1 month later. The operative indications for primary malignant melanoma of the esophagus are discussed in this report.     

Amelanotic malignant melanoma of the esophagus. Report of a case

Primary malignant melanomas of the esophagus are rare neoplasms with aggressive behavior and tendency to lymphatic and hematogenous spread. We report on a patient affected with a primary amelanotic melanoma of the esophagus synchronous to a squamous cell carcinoma of the epiglottis and treated by subtotal esophagectomy. A 58-year-old woman presented with a three-month history of dysphagia, retrosternal pain and weight loss. An upper gastrointestinal endoscopy revealed a 3 cm, non pigmented, polypoid mass of the middle esophagus and biopsy was consistent with undifferentiated carcinoma. Fiberoptic bronchoscopy revealed a 0.5 cm, polypoid lesion of the right aspect of the epiglottis consistent with a squamous cell carcinoma. The esophageal neoplasm was treated by subtotal esophagectomy while the squamous cell carcinoma of the epiglottis was referred to radiotherapy 1 month after surgery. Microscopy showed diffuse proliferation of anaplastic cells with multiple mitotic figures, marked nuclei and multilobulated nucleoli. The neoplasm stained positive for HBM-45 antigen and S-100 protein. Tumor stage was pT1N0M0. Review of patient's medical history and exploration of skin and mucous membranes failed to reveal malignant lesions and definitive diagnosis was primary amelanotic malignant melanoma of the esophagus. The patient died 16 months after surgery of disseminated disease. In conclusion the present case confirms that primary malignant melanomas of the esophagus have a dismal outcome even in cases of early-stage lesions amenable to surgical resection.     

Primary melanoma of the esophagus

A case of primary malignant melanoma of the esophagus is described. Primary malignant melanoma of the esophagus is rare, reaching only 0.1% of all esophageal tumors. The differential diagnosis is often difficult: the clinical features are similar to those of squamous cell carcinoma and, because of its potentially widespread submucosal growth, the bioptic and/or cytologic examinations are frequently negative. The surgical approach with esophagectomy is actually the treatment of choice. However, the prognosis is poor with a 5-year survival of 4.2%.     

Curatively resected primary malignant melanoma of the esophagus: Report of a case

We report herein a rare case of primary esophageal malignant melanoma in a 49-year-old Japanese woman who presented with a 3-week history of dysphagia. Esophagogram and esophagoscopy demonstrated a polypoid tumor in the upper to mid-thoracic portion of the esophagus, and a radical subtotal esophagectomy was performed through a right thoracotomy. Histological and immunohistochemical studies proved this tumor to be a primary esophageal malignant melanoma. She received no postoperative adjuvant therapy and no signs of recurrence have been clinically observed for the 22 months since her operation.     

Palliation of a primary malignant melanoma of the distal esophagus by stent implantation

BACKGROUND: A 55-year-old woman suffering from progressive dysphagia, retrosternal pain, and annoying foetor ex ore is described. Esophagogastroscopy showed a dark, necrotic tumor extending from 28 cm below the front teeth to the esophagogastric border, and biopsy showed it to be a primary malignant melanoma. The underlying progressive tumor stage with pericardial infiltration and intra-abdominal lymph node metastasis precluded the possibility of curative surgical treatment. METHODS: For palliation, we implanted a metal stent (Ultraflex, Microvasive, Boston Scientific Corporation, Watertown, MA, USA) in the distal esophagus to alleviate the dysphagia. RESULTS: Permanent recanalization of the tumor-obstructed esophagus by stent implantation alleviates symptoms, thereby significantly improving quality of life. Radiochemotherapy can be performed despite the presence of the stent. CONCLUSIONS: Surgery is the therapy of choice for resectable primary malignant melanoma of the esophagus. Endoscopic therapy should be considered for alleviating dysphagia if surgery is impossible.     

Primary malignant melanoma of the esophagus treated with subtotal esophagectomy: a case report

Background

Primary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis. There are few reports of early-stage cases in which tumor invasion reached the lamina propria or muscularis mucosae, as in the present case. A standard treatment for early-stage PMME has not yet been established. The present study aimed to summarize previous reports and to discuss the indications for surgical treatment of early-stage primary malignant melanoma of the esophagus.

Case presentation

A 70-year-old woman with PMME was referred to our hospital. She underwent thoracoscopic and laparoscopic subtotal esophagectomy with lymphadenectomy. The resected specimen showed melanocytosis and junctional activity. Melanoma-specific antigens melan-A, S-100, and HMB45 were detected by immunohistochemical staining. The pathological diagnosis was pT1a-MM, pN0, pM0, and pStage IA. She remains alive without evidence of recurrence 39 months later.

Conclusion

Subtotal esophagectomy with regional radical lymphadenectomy could be recommended to patients with early-stage primary malignant melanoma of the esophagus, and curative surgical resection could improve their prognosis.

     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is exceedingly rare. We identified six patients seen at Memorial Hospital for Cancer and Allied Diseases over a period of 35 years. All patients were Caucasian, with an age range of 30 to 74 years (mean: 60 years). There were three men and three women. No association was noted with tobacco or ethanol use, nor was there a personal or family history of malignant melanoma. Symptoms were related to obstruction or hemorrhage. All tumors were polypoid and had attained large size at the time of initial diagnosis. Histologically, the melanomas had epithelioid, spindle-cell, and pleomorphic areas with focal melanin production. An intraepithelial "in situ" component was present in five cases and melanosis of the non-neoplastic esophagus in five. All six neoplasms were immunoreactive for S-100 protein, and none reacted with anticytokeratins. Two cases examined ultrastructurally showed premelanosomes. All patients were treated by esophagogastrectomy. The mean survival for four patients was only 2.1 months. The two remaining patients are alive at 5.5 and 11 months.     

Primary malignant melanoma of the esophagus

Summary This report describes a case of primary malignant melanoma of the esophagus in a 66-year-old man treated by esophagogastrectomy. Radiographic, endoscopic, echoendoscopic and histological features are given and a short review of the literature is presented.     

Clinical and Pathological Characteristics of Carcinosarcoma of the Esophagus: Report of Four Cases

Carcinosarcoma of the esophagus is a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. Four out of 850 patients with carcinoma of the esophagus or the cardiac portion of the stomach undergoing operation at Capital Hospital, Beijing, had carcinosarcoma of the esophagus. They ranged from 50 to 58 years old, but only 45% of all 850 patients with carcinoma were in the age group from 51 through 60 years old. All 4 patients with carcinosarcoma of the esophagus were men.On barium swallow esophagogram, the 4 patients had a characteristic intraluminal polypoid lesion in the middle third of the esophagus. Such lesions of the esophagus also can occur in patients with benign fibrovascular polyps, leiomyoma, and the polypoid form of esophageal carcinoma and esophageal melanoma. The last two can be differentiated from carcinosarcoma only by pathological examination after excision.After radical excision and esophagogastrostomy, the 4 patients were followed up for 19, 4, 4, and 3 years. They were in good condition without recurrence.     

Primary malignant melanoma of the esophagus

The primary malignant melanoma of the esophagus is a rare tumor. The study aim was to report two cases, one treated by esophagectomy without thoracotomy and the other one by Lewis-Santy type esophagectomy. Both patients had recurrence. One died at the 24th month with liver metastases. The other one who had a cervical invaded lymph node, treated by radio-chemotherapy, is actually in complete remission 9 years after the diagnosis.     

原发性消化道黑色素瘤的临床分析

目的 总结原发性消化道黑色素瘤的临床特点。方法 回顾性分析我院近10年住院治疗的8例原发性消化道黑色素瘤临床资料并复习献。结果 8例原发性消化道黑色素瘤中，原发灶位于直肠6例，小肠1例，食管1例，除1例直肠黑色素瘤术前得到确诊外，其余7例均被提诊，直肠黑色素瘤以便血，肛门疼痛和排便困难为主要症状；多表现为息肉样，均位于距齿状线以上5cm以内；少有色素沉着，小肠黑色素瘤以梗阻，腹痛，贫血为主要症状；造影和CT有助于发现病变，但确诊仍需病理学，食管黟 以素瘤多为黏膜下；胃镜可发现色素沉着；病理活检可协肋诊断。结论 原发性消化道黑色素瘤的临床表现与其他肿瘤类似，极易误诊，病理活检是确诊的主要手段。     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is rare, and its symptoms are similar to those of squamous cell carcinoma. This tumor tends to be polypoid, pediculated, and irregular. Hematogenic and lymphogenic metastases are common. Surgical resection with reestablished continuity of the gastrointestinal tract is the treatment of choice, and postoperative irradiation may be useful. Despite these measures, however, the prognosis is poor, with a 5-year survival of 4.2%. The case of a 47-year-old man with esophageal melanoma is described, and a review of the world literature is presented.     

胃肠道恶性黑色素瘤70例临床分析

目的 探讨胃肠道恶性黑色素瘤的诊治方法,提高诊治水平.方法 总结1965年7月至2007年6月收治的70例胃肠道恶性黑色素瘤患者的临床资料.结果 70例患者中男性27例,女性43例,年龄25～75岁,中位年龄53岁,其中50例发生于直肠,10例发生于肛管,10例发生于食管.1、3、5年生存率分别为48.3%、14.6%、6.5%,中位生存时间为379 d.63例接受手术治疗,单纯手术的25例患者和术后辅助化疗、放疗、生物治疗等综合治疗的38例患者的总生存率无统计学差异,Ⅲ期患者综合治疗组较单纯手术组生存率显著升高.风险因素分析提示病变深度为胃肠道恶性黑色素瘤的危险因素.结论 手术加综合治疗能提高Ⅲ期胃肠道恶性黑色素瘤的生存率;病变深度是影响生存率的风险因素.     

Unusual malignant neoplasms of the esophagus. Oat cell carcinoma, melanoma, and sarcoma.

Primary noncarcinomatous malignant neoplasms of the esophagus are uncommon and data concerning treatment and results are sparse. To evaluate the results of therapy in this group, we reviewed the records of 32 patients with primary esophageal malignant tumors of unusual histologic type. Thirteen patients (41%) had sarcoma, eight (25%) melanoma, and 11 (34%) had oat cell carcinoma. Dysphagia was present in 78% (25/32) of the patients for a median of 13 weeks before diagnosis. Location of the esophageal primary tumor was upper third in four patients (12%), middle third in 12 (38%), and lower third in 16 (50%). Treatment consisted of esophagectomy in 10 of 13 patients with sarcoma (77%), seven of eight with melanoma (88%), and three of 11 with oat cell carcinoma (27%). Patients not undergoing resection received chemotherapy or radiation therapy, or both. The 3- and 5-year survival rates were 46% and 23% for sarcoma (median 20 months), 13% and 0% for melanoma (median 5 months), and 0% and 0% for oat cell carcinoma (median 5 months), respectively. Distant disease was the initial form of recurrence in 73% (11/15) of patients undergoing curative therapy. Surgical resection appears indicated for localized primary esophageal sarcoma. Optimum treatment of primary esophageal melanoma is less clear, but surgical resection may be of benefit in selected patients. Esophageal oat cell carcinoma is a systemic disease necessitating systemic therapy with local therapy reserved for palliation of dysphagia.     

Primary malignant melanoma of the esophagus

Three cases of primary malignant melanoma of the oesophagus are presented and the literature is briefly reviewed. This rare disease affects predominantly males in the sixth decade of life or later and the clinical and radiologic features are indistinguishable from those of more common oesophageal carcinomas. The tumours are often polypoid, located mainly in the lower two-thirds of the esophagus, and their histologic features resemble those of lentigo maligna melanoma, but with more aggressive biologic behavior. Because of the potential for extensive intramucosal involvement, multicentricity and high local recurrence rate, surgical treatment requires radical excision with a much greater margin than for the common squamous cell carcinomas. Though the outlook is poor, surgery is the favoured treatment with palliative or curative intent, with a 5-year survival rate of 4.2%. Radiotherapy, chemotherapy and immunostimulation currently serve mainly as palliative or adjunctive measures.     

Primary malignant melanoma of the esophagus: a case report

Primary malignant melanoma of the esophagus is an uncommon tumor associated with a poor survival (5% at 5 years), even when resected at an early stage. Because its symptoms are no different from those of other malignant tumors of the esophagus, histopathologic examination is usually needed to reach a definitive diagnosis. A 57-year-old white nonsmoking nonalcoholic woman was referred to our department after 2 months of increasing dysphagia, odynophagia, and weight loss (5 kg in 2 months). Esophagogastroscopy revealed a dark blue, pediculated, polypoid lesion. Biopsies were taken. Endoscopic ultrasound showed a hyperechoic heterogeneous tumor. Barium esophagogram showed a filling defect of ~ 6 cm in the middle-low esophagus, and thoracic and abdominal computed tomography (CT) scan showed a well-delimited esophageal tumor with no clear lymph node enlargement. The pathology report described a proliferation of small spindle-shaped or stellate cells arranged in a spiral or fascicular structure. All tumor cells were intensively positive for immunoreaction, using HMB45 antimelanoma antibodies. To remove the tumor, distal esophagectomy through a double abdominal and thoracic approach was performed. No postoperative complications were reported and no chemo- or radiotherapy was given. The patients is still alive with no evidence of recurrence at 9 months after the operation.