A Retrospective Study, an Initial Lesion of Primary Malignant Melanoma of the Esophagus Revealed by Endoscopy

Abstract

A 66-year-old man presented to his previous physician with epigastric discomfort in 2014. He was then referred to our hospital due to suspected primary malignant melanoma of the esophagus (PMME). A biopsy showed atypical cells containing melanin granules. A diagnosis of PMME was thus made. We investigated the endoscopic findings of the previous physician, which revealed a black point-like pigmentation at the same site since 2009. In 2010, black pigmentation was also observed at the same site. Although esophageal melanosis was suspected, no biopsy was performed. This case demonstrates the process by which esophageal melanomas develop into malignant melanomas.

Keywords: PMME; malignant melanoma; primary malignant melanoma of the esophagus.

Figure 1.

Endoscopic image (A), endoscopic ultrasonography (B), and esophageal barium examination (C) of the patient. An elevated lesion with an lobulated-black tone in the mid-thoracic esophagus at a site 37-43 cm from the incisors was revealed, with some areas with a white moss appearance (A). Endoscopic ultrasonography demonstrated a low echoic legion, a solid tumor mass, in the esophageal wall (B). Esophageal barium examination showed rising, steep ridged tumors that were localized in the mid-esophagus of the chest (C).

Figure 2.

Histologic image of biopsy specimens. The atypical cells containing melanin granules were identified (A). HMB45 staining was positive (B).

Figure 3.

The time course for tumor progression from a black nodule to PMME. A black nodule was recognized in the mid-thoracic esophagus in 2009 (A). In 2010, a nodule at the same site had grown to 5 mm in size with a slightly raised profile (B), and there was thin mottled black pigmentation around the nodule (C). PMME was confirmed in the mid- thoracic esophagus in 2014 (D).