A Case of Primary Malignant Melanoma of the Esophagus with Submucosal Invasion

Abstract

We report a case of primary malignant melanoma of the esophagus (PMME). A 67-year-old man was referred to our hospital because of dysphagia. Upper gastrointestinal endoscopy revealed a polyploid tumor in the lower thoracic esophagus. Biopsy specimens revealed large atypical cells containing brown granules, and immunohistochemical staining was positive for HMB-45. Pigmented lesions of the skin, rectum, or eyes were not observed, and we diagnosed the tumor as PMME. A subtotal esophagectomy via right thoracotomy and laparotomy was performed. Histopathological examination showed lymph node metastasis and tumor cell invasion to the submucosal layer (T1b). According to the Japanese classification of Esophageal cancer, the pathological stage was stage Ⅱ T1bN1M0. Adjuvant chemotherapy was not performed because of postoperative complications. Fourteen months after the operation, the tumor relapsed in the lung, liver, and retroperitoneum. Chemotherapy was administered, but the patient died of tumor recurrence 20 months after the operation. The prognosis of PMME is poor, as is that for cases of submucosal invasion. Investigation of the long-term prognosis and efficacy of progressive immunochemotherapy are very important to improve the prognosis of PMME.

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

“…Invasion deeper than T2 (hazard ratio: 2.288, p = 0.0327, 95% CI: 1.071–4.878) [ 14 ] and lymph node metastasis (hazard ratio: 15.05, p = 0.013, 95% CI: 1.757–128.795) [ 15 ] have been reported as predictive factors for worse survival. On the contrary, Takahashi et al [ 16 ] reviewed 33 patients with invasion depth of T1b, pointed out the poor prognosis of T1b patients because of a high recurrence rate (20 of 33 patients), and reported that the 5-year survival rate was only 29.4%.…”