The presence of acantholysis in squamous cell carcinomas (SCC) may rarely be so extreme that, histologically, it mimics a vascular tumour. However, careful histological examination and immunohistochemical study usually lead to the correct diagnosis. We describe such a case to highlight the clinico-pathological features of this rare form of cutaneous malignancy and to emphasize the difficulties in establishing the correct diagnosis. We also review similar cases reported in the literature. Pseudovascular SCC shows a higher degree of recurrence and metastasis than other variants of SCC. Acantholytic foci in these tumours may demonstrate changes in keratinocyte differentiation markers, and this may explain the more aggresive biological behaviour in the pseudovascular variant of SCC.

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Introduction: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site.Case report: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma.Discussion: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.Key words: Primary melanoma of esophagus. Metastasis. Treatment. CASE REPORTA 67-year-old patient presents with clinical dysphagia, predominantly to solids, for the past two months, with no associated vomiting or constitutional syndrome. His history is remarkable for psoriasis, smoking, and alcohol abuse. No adenopathies could be palpated in accessible regions, his abdomen was soft, non-tender, and depressible, and no masses or organomegalies could be identified. No malignancy-suggestive skin lesions were seen.As a part of the study a gastroscopy was performed, which revealed a pigmented, villous, ulcerated, pediculated polypoid lesion in the distal esophagus, which was friable to the touch and did not block the esophageal lumen. Biopsy samples were taken, which were consistent with squamous-cell melanoma positive for immunohistochemical markers S100 and HMB45, and negative for carcinoembryonic antigen (CEA) and cytokeratins.The extension study was completed with a chest-abdominal CT scan, which revealed an endoluminal esophageal growth compatible with neoplasm at the distal third of the esophagus, in the absence of either local infiltration or distant metastases evidence (Fig. 1).A TEP scan was ordered, which showed hypermetabolism at the distal third of the esophagus and no metastatic uptake suggestive of tumor infiltration. A diagnosis of primary esophageal melanoma was then reached by exclusion.Received: 01-07-2016 Accepted: 21-07-2016Correspondence: Laura Granel-Villach. Department of General and Digestive Surgery. Hospital General de Castellón. Avda. Benicássim, s/n. 12004 Castellón, Spain e-mail: laura_9487@yahoo.es. Granel-Villach L, Moya-Sanz MA, Escrig-Sos VJ, Fortea-Sanchís C, Martínez-Lahuerta C, Tornador-Gaya N...

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