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Primary Malignant Melanoma of the Esophagus
Image of the Month Primary Malignant Melanoma of the Esophagus MONICA AWSARE,* JOSEPH S. FRIEDBERG,‡ and ROBERT COBEN* *Departments of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Division of Thoracic Surgery, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
A
46-year-old woman presented with progressive dysphagia for 2 months. On endoscopy, she was found to have a large, submucosal, esophageal mass extending from 28 to 34 cm from the incisors and obstructing 75% of the esophageal lumen (Figure A). Endoscopic ultrasound with fine-needle aspiration revealed a hyperechoic lesion, with cross-sectional dimensions of 1.7 ⫻ 2.6 cm, arising from the submucosa and not involving the muscularis propia (Figure B). The cytology was nondiagnostic, showing only atypical cells. The patient then underwent thoracoscopy. The mass was enucleated easily from its investing muscular surroundings. Frozen section analysis was most consistent with metastatic melanoma. This initial diagnosis of metastatic melanoma was the impetus to stop with a local resection that yielded negative margins, rather than escalate to a complete esophagectomy. Histopathology revealed malignant melanoma with significant junctional tumor activity, confirming the diagnosis of primary esophageal melanoma (Figure C). After surgery, the patient underwent adjuvant chemotherapy. Sixteen months after resection, a recurrent mass was seen on surveillance endoscopy. Endoscopic ultrasound confirmed a recurrent esophageal mass that revealed malignant cells on fineneedle aspiration. The patient then underwent complete esophagectomy. Histopathology was consistent with a malignant melanoma with negative margins; all lymph nodes were negative. Primary melanoma of the esophagus is a rare malignancy, accounting for only .1%–.2% of all esophageal neoplasms.1 The presence of melanocytic tumor activity at the junction of the squamous epithelium and the lamina propria establishes the diagnosis of primary esophageal melanoma.2 Surgical resection is currently the treatment of choice for this disease. The tendency for these tumors to spread submucosally may mandate a radical surgical resection to achieve complete extirpation.3
References 1. Sabanathan S, Eng J, Pradhan GN. Primary malignant melanoma of the esophagus. Am J Gastroenterol 1989;84:1475–1481. 2. Allen AC, Spitz S. Malignant melanoma: a clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer 1953;6:1– 45. 3. Sabanathan S, Eng J. Primary malignant melanoma of the esophagus. Scand J Thorac Cardiovasc Surg 1990;24:83– 85.
© 2005 by the American Gastroenterological Association
1542-3565/05/$30.00 PII: 10.1053/S1542-3565(05)00362-9 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:xxvii
A
46-year-old woman presented with progressive dysphagia for 2 months. On endoscopy, she was found to have a large, submucosal, esophageal mass extending from 28 to 34 cm from the incisors and obstructing 75% of the esophageal lumen (Figure A). Endoscopic ultrasound with fine-needle aspiration revealed a hyperechoic lesion, with cross-sectional dimensions of 1.7 ⫻ 2.6 cm, arising from the submucosa and not involving the muscularis propia (Figure B). The cytology was nondiagnostic, showing only atypical cells. The patient then underwent thoracoscopy. The mass was enucleated easily from its investing muscular surroundings. Frozen section analysis was most consistent with metastatic melanoma. This initial diagnosis of metastatic melanoma was the impetus to stop with a local resection that yielded negative margins, rather than escalate to a complete esophagectomy. Histopathology revealed malignant melanoma with significant junctional tumor activity, confirming the diagnosis of primary esophageal melanoma (Figure C). After surgery, the patient underwent adjuvant chemotherapy. Sixteen months after resection, a recurrent mass was seen on surveillance endoscopy. Endoscopic ultrasound confirmed a recurrent esophageal mass that revealed malignant cells on fineneedle aspiration. The patient then underwent complete esophagectomy. Histopathology was consistent with a malignant melanoma with negative margins; all lymph nodes were negative. Primary melanoma of the esophagus is a rare malignancy, accounting for only .1%–.2% of all esophageal neoplasms.1 The presence of melanocytic tumor activity at the junction of the squamous epithelium and the lamina propria establishes the diagnosis of primary esophageal melanoma.2 Surgical resection is currently the treatment of choice for this disease. The tendency for these tumors to spread submucosally may mandate a radical surgical resection to achieve complete extirpation.3
References 1. Sabanathan S, Eng J, Pradhan GN. Primary malignant melanoma of the esophagus. Am J Gastroenterol 1989;84:1475–1481. 2. Allen AC, Spitz S. Malignant melanoma: a clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer 1953;6:1– 45. 3. Sabanathan S, Eng J. Primary malignant melanoma of the esophagus. Scand J Thorac Cardiovasc Surg 1990;24:83– 85.
© 2005 by the American Gastroenterological Association
1542-3565/05/$30.00 PII: 10.1053/S1542-3565(05)00362-9 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:xxvii