Unusual clinical course of metachronous melanomas of the upper digestive system

Abstract

Melanoma of the gastrointestinal tract is a rare, highly malignant neoplasm of poor prognosis. This is description of an unusual case of surgically treated patient with two metachronous malignant melanomas of the stomach and the esophagus. The former lesion was located in the cardia and effectively treated with R0 total gastrectomy. The latter was recognized after 67 mo and appeared as irregular, flat, pigmented areas located in the mid esophagus. Subtotal esophagectomy via right-sided thoracotomy, laparotomy and left-sided cervicotomy was performed, but neoplastic cells were found in distal margin (R1). Fourteen months after esophagectomy multiple lung metastases were detected. Patient died 2 mo later.

Figure 1

Gastric melanoma (HE, original magnification ×100).

Figure 2

Endoscopic picture of esophageal melanoma.

Figure 3

Esophageal melanoma (HE, original magnification ×100).

Figure 4

Strongly positive immunostaining for HMB45 in both esophageal melanoma and intraepithelial melanocytic lesion (LSAB2/HRP, original magnification ×100).