Early stage primary malignant melanoma of the esophagus

The patient, a 60-year-old man with slight abdominal discomfort, was examined by gastroscopy. Esophagoscopy revealed that the mucosa from 34 to 39 cm was black but no polypoid or ulcerative lesions were evident (Fig. 1). Biopsies were taken and immunohistochemical study showed PMME. No abnormalities were noted on physical examination and, specifically, no pigmented lesions of the skin or eyes were observed. There was no evidence of regional or distant metastases. Endoscopic US showed that the surfaces of the 3 layers were smooth and the internal echo architecture was homogeneous. The patient underwent subtotal esophagectomyvia the transhiatal approach and a high cervical esophagogastric anastomosis was performed. No tumor extension was seen beyond the esophageal wall. No enlarged or blackish lymph nodes were identified. The unstretched surgical specimen contained a tumor measuring 4.0 × 2.0 cm in the lower esophagus. Microscopically, it was composed of rare tumor cells containing pigmented granules. Junctional activity was found in the epithelium overlying and adjacent to the tumor. Immunohistochemistry demonstrated focal areas that stained positive for the S-100 and HMB45 protein and verified the diagnosis of an R0-resected PMME analogous to a pT1 N0 M0 stage cancer. The entire esophagus was serially cut into 3 mm wide strips. Through the microscope, tumor cells were found in 5 of 26 sections and were within the mucosal layer (Fig. 2). The postoperative course was uneventful except for a short-term cervical anastomotic leak. The patient was discharged on hospital day 33 in good condition.