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Zhou SL, Zhang LQ, Zhao XK, Wu Y, Liu QY, Li B, Wang JJ, Zhao RJ, Wang XJ, Chen Y, Wang LD, Kong LF. Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review. World J Gastrointest Oncol 2022; 14:1739-1757. [PMID: 36187400 PMCID: PMC9516654 DOI: 10.4251/wjgo.v14.i9.1739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/24/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary malignant melanoma of the esophagus (PMME) is a rare malignant disease and has not been well characterized in terms of clinicopathology and survival.
AIM To investigate the clinical features and survival factors in Chinese patients with PMME.
METHODS The clinicopathological findings of ten cases with PMME treated at Henan Provincial People’s Hospital were summarized. Moreover, the English- and Chinese-language literature that focused on Chinese patients with PMME from 1980 to September 2021 was reviewed and analyzed. Univariate and multivariate analyses were employed to investigate the clinicopathologic factors that might be associated with survival.
RESULTS A total of 290 Chinese patients with PMME, including ten from our hospital and 280 from the literature were enrolled in the present study. Only about half of the patients (55.8%) were accurately diagnosed before surgery. Additionally, 91.1% of the patients received esophagectomy, and 88 patients (36.5%) received adjuvant therapy after surgery. The frequency of lymph node metastasis (LNM) was 51.2% (107/209), and LNM had a positive rate of 45.3% even when the tumor was confined to the submucosal layer. The risk of LNM increased significantly with the pT stage [P < 0.001, odds ratio (OR): 2.47, 95% confidence interval (CI): 1.72-3.56] and larger tumor size (P = 0.006, OR: 1.21, 95%CI: 1.05-1.38). The median overall survival (OS) was 11.0 mo (range: 1-204 mo). The multivariate Cox analysis showed both the pT stage [P = 0.005, hazard ratio (HR): 1.70, 95%CI: 1.17-2.47] and LNM (P = 0.009, HR: 1.78, 95%CI: 1.15-2.74) were independent prognostic factors for OS. The median disease-free survival (DFS) was 5.3 mo (range: 0.8-114.1 mo). The multivariate analysis indicated that only the advanced pT stage (P = 0.02, HR: 1.93, 95%CI: 1.09-3.42) was a significant independent indicator of poor RFS in patients with PMME.
CONCLUSION The correct diagnosis of PMME before surgery is low, and physicians should pay more attention to avoid a misdiagnosis or missed diagnosis. Extended lymph node dissection should be emphasized in surgery for PMME even though the tumor is confined to the submucosal layer. Both the LNM and pT stage are independent prognosis factors for OS, and the pT stage is the prognosis factor for DFS in patients with PMME.
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Affiliation(s)
- Sheng-Li Zhou
- Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Lian-Qun Zhang
- Department of Gastroenterology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Xue-Ke Zhao
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Henan Key Laboratory for Esophageal Cancer Research, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yue Wu
- Department of Gastroenterology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Qiu-Yu Liu
- Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Bo Li
- Department of Radiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Jian-Jun Wang
- Department of Thoracic Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Rui-Jiao Zhao
- Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Xi-Juan Wang
- Department of Pediatrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Yi Chen
- Clinical Research Service Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Li-Dong Wang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Henan Key Laboratory for Esophageal Cancer Research, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ling-Fei Kong
- Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
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The Thousand Faces of Malignant Melanoma: A Systematic Review of the Primary Malignant Melanoma of the Esophagus. Cancers (Basel) 2022; 14:cancers14153725. [PMID: 35954389 PMCID: PMC9367585 DOI: 10.3390/cancers14153725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
Primary Malignant Melanoma of the Esophagus (PMME) is an extremely rare cancer of the esophagus, accounting for 0.1−0.8% of all oro-esophageal cancers and <0.05% of all melanoma subtypes, with an estimated incidence of 0.0036 cases per million/year. We conduct a careful analysis of the literature starting from 1906 to the beginning of 2022, searching the PubMed, Science.gov, Scopus and Web of Science (WoS) databases. A total of 457 records were initially identified in the literature search, of which 17 were duplicates. After screening for eligibility and inclusion criteria, 303 publications were ultimately included, related to 347 patients with PMME. PMME represents a very rare entity whose very existence has been the subject of debate for a long time. Over time, an increasing number of cases have been reported in the literature, leading to an increase in knowledge and laying the foundations for a discussion on the treatment of this pathology, which still remains largely represented by surgery. In recent times, the possibility of discovering greater mutations in gene hotspots has made it possible to develop new therapeutic strategies of which nivolumab is an example. Future studies with large case series, with clinicopathological and molecular data, will be necessary to improve the outcome of patients with PMME.
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Sanlorenzo M, Ribero S, Osella Abate S, Mariani S, Strignano P, Salizzoni M, Savoia P, Fierro MT, Quaglino P. Genetic mutations in primary malignant melanoma of the esophagus: case report and literature review. GIORN ITAL DERMAT V 2020. [PMID: 33295742 DOI: 10.23736/s0392-0488.16.05174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The most frequent genetic aberrations in mucosal melanoma are activating mutations of c-KIT. Primary malignant melanomas of esophagus (PMME) are uncommon entities, with aggressive biological behavior and poor prognosis. The better definition of their genotype could improve therapeutic options. We report a case of a 66 years old man with a PMME in the lower third of the esophagus. Analysis of c-kit, KRAS, NRAS and BRAF genes resulted negative for mutations. On the basis of a computerized (PuMed/Medline) bibliography search we retrieved a total of other 35 cases of PMME analyzed for genetic alterations in RAS, BRAF, and KIT. When we compared mutations frequency of PMME with those of other mucosal melanomas, it appeared that PMME are characterized by a relative higher percentage of NRAS mutations. PMME seem to show a specific pattern of genetic alterations suggesting that they could represent a distinct entity among mucosal melanomas.
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Affiliation(s)
- Martina Sanlorenzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simona Osella Abate
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.,Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sara Mariani
- Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Strignano
- General Surgery and Liver Transplant Center, Città della Salute e della Scienza, Turin, Italy
| | - Mauro Salizzoni
- General Surgery and Liver Transplant Center, Città della Salute e della Scienza, Turin, Italy
| | - Paola Savoia
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria T Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
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Abstract
Primary malignant melanoma of esophagus (PMME) is a rare malignant tumor of esophagus. This study aimed to investigate the clinic pathologic characteristics and analyze the factors that might affect the prognosis of PMME patients.A total of 20 PMME patients who underwent surgical treatment in our hospital from 1975 to 2017 were analyzed. The clinical data, surgical and pathologic features of all patients were collected.For 20 PMME patients, the average age was 57.3 ± 10.7 years, and the male patients account for 75%. Most of the tumors (95%) were located in the middle and lower of the esophagus. There were 7 patients with primary tumor invasion beyond the muscular layer (T3 + T4) and 10 patients with lymph node metastasis (LNM). The median survival time of 20 patients was 12 months, and the 1-year and 5-year survival rates were 50% and 16.9%, respectively. The probability of LNM in tumors confined to submucosa (T1) and myometrium (T2) was lower than that in tumors with deeper invasion (T3, T4) (P = .035). Multivariate analysis showed that tumor node metastasis (TNM) staging was the independent prognostic factor for survival of PMME patients (hazard ratio [95% confidence interval], 4.15 [1.36-12.67]; P = .012).For PMME patients, tumors with deeper invasion were more likely to have LNM, and TNM staging was an independent predictor of prognosis for survival. Early detection of the disease and radical resection of the tumor are critical for better survival of the PMME patients.
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Iwasaki K, Ota Y, Yamada E, Takahashi K, Watanabe T, Makuuchi Y, Suda T, Osaka Y, Seshimo A, Katsumata K, Tsuchida A. Primary malignant melanoma of the esophagus with multiple lymph node metastases: A case report and literature review. Medicine (Baltimore) 2020; 99:e18573. [PMID: 32481357 DOI: 10.1097/md.0000000000018573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Primary malignant melanoma of the esophagus (PMME) is a very rare malignancy accounting for only 0.1% to 0.2% of all malignant esophageal lesions. Presently, there are no standard strategies or clear guidelines for PMME treatment. PATIENT CONCERNS Herein, we report a patient who had PMME with multiple lymph node metastases (LNMs) who was treated successfully by esophagectomy. In March 2018, a 74-year-old man with symptoms of continuous dysphagia was referred to our hospital. DIAGNOSIS Upper gastrointestinal endoscopic examination revealed melanin pigmentation in the middle thoracic esophagus and a pigmented polypoid mass in the lower esophagus. Histopathological examination of the endoscopic biopsy specimen revealed malignant melanoma. Contrast-enhanced computed tomography showed a 3 cm tumor lesion with several enlarged lymph nodes without distant metastasis. The preoperative diagnosis based on the TNM classification was cT2N2M0 stage III. INTERVENTIONS The patient underwent esophagectomy with lymph node dissection. OUTCOMES Histopathological examination showed that the tumor extended to the submucosal layer of the esophageal wall, with multiple LNMs. Although multiple LNMs were detected, computed tomography scan 15 months after surgery showed no recurrence. Additionally, we analyzed the relationship between the overall survival and the clinicopathological factors including LNMs in 48 previously reported cases of PMME that were surgically treated. LESSONS To our knowledge, this is the first report on the effect of LNMs on the prognosis of PMME patients. The analysis revealed the prognostic value of the TNM stage. Early tumor detection and esophagectomy with lymph node dissection may play as key factors for achieving a better overall survival of PMME patients.
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Affiliation(s)
- Kenichi Iwasaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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Urabe M, Haruta S, Ohkura Y, Inoshita N, Yago A, Koga S, Tanaka T, Ueno M, Udagawa H. Clinicopathological presentations and surgical outcomes of esophageal melanoma. Asian Cardiovasc Thorac Ann 2019; 27:548-553. [PMID: 31319672 DOI: 10.1177/0218492319866064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Primary malignant melanoma of the esophagus is a rare tumor with a poor prognosis; the optimal treatment strategy has yet to be established. This study aimed to clarify clinical features, courses, and outcomes of patients undergoing surgical resection of primary malignant melanoma of the esophagus. Methods Six patients with primary malignant melanoma of the esophagus, in whom the absence of other primary melanomas had been confirmed, were selected from the medical database maintained in Toranomon Hospital. Their clinicopathological characteristics and long-term outcomes were retrospectively reviewed and analyzed. Results All 6 patients (five males and one female) underwent radical esophagectomy with three-field regional lymphadenectomy, and none received neoadjuvant therapy. Tumor invasion was classified into T1 in 5 (83%) cases and T3 in one (17%). Four (67%) patients had nodal metastases (one N1, one N2 and two N3). No distant metastatic lesions were detected preoperatively in any of our cases. Postoperative surveillance revealed recurrence in all 6 patients, and 5 (83%) died of the disease. The median overall survival was 24 months. One patient with a T3N3M0 tumor was treated after surgery with a dacarbazine-nimustine-vincristine regimen followed by irradiation for bone recurrence and survived for 87 months postoperatively. Another patient with a T1N3M0 tumor who survived for 27 months after liver and bone recurrence was treated with nivolumab, ipilimumab, and dacarbazine. Conclusion Although the courses of patients with primary malignant melanoma of the esophagus were consistently unfavorable, surgical resection with multidisciplinary therapeutic modalities may prolong survival in some cases.
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Affiliation(s)
- Masayuki Urabe
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shusuke Haruta
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yu Ohkura
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Naoko Inoshita
- 2 Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Akikazu Yago
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shuhei Koga
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tsuyoshi Tanaka
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- 1 Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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Primary malignant melanoma of esophagus: clinicopathologic characterization of 20 cases including molecular genetic profiling of 15 tumors. Mod Pathol 2019; 32:957-966. [PMID: 30760858 PMCID: PMC8210848 DOI: 10.1038/s41379-018-0163-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 02/08/2023]
Abstract
Primary malignant melanoma of esophagus is very rare, and its clinicopathologic and genetic features have not been extensively investigated. In this study, 20 tumors from 14 male and 6 female patients (40-79 years old) were evaluated. Dysphagia, chest pain, and weight loss were frequent symptoms. Thirteen melanomas, including two with multiple lesions, involved the distal third of esophagus. The median tumor diameter was 6 cm. Epithelioid morphology, moderate atypia, and pigmentation were typical findings. None of the patients had melanoma elsewhere, and all tumors exhibited a junctional peri-epithelial component consistent with a primary lesion. The median mitotic activity was 11 per 10 high-power fields (range, 0-31). Nine patients died of tumor within 4-22 months, however, two showed long-term (96 and 104 months) survival. In 15 cases, tissue for further immunohistochemical and molecular studies were available. BRAF, KIT, and NRAS mutation status was assessed by Sanger sequencing in all 15 tumors. The next-generation sequencing of 50 or 409 genes was performed in five and three cases, respectively. IGF1R expression indicating activation of the IGF axis was seen in 82% (9/11) of tumors. However, no BRAF mutations were identified. In 33% (5/15) of tumors, NRAS mutations were detected. KIT expression was seen in 50% (7/14) of melanomas including single KIT mutant. Two of three tumors evaluated with 409 genes panel revealed multiple driver mutations indicating sub-clonal expansion, whereas a single mutation (TSC1 p.H371Q) was the sole change in the third case. SF3B1 p.K666T and p.R625C mutations were detected in two cases. However, no co-occurrence of SF3B1 and GNAQ or GNA11 mutations, seen in uveal melanoma, was detected. FBXW7 p.R465C and p.R479G mutations, linked to cancer progression, were found in two of eight tumors. In summary, esophageal melanoma mutation profile indicates complexity of molecular mechanisms underlying its pathogenesis.
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Hashimoto T, Makino T, Yamasaki M, Tanaka K, Miyazaki Y, Takahashi T, Kurokawa Y, Motoori M, Kimura Y, Nakajima K, Morii E, Mori M, Doki Y. Clinicopathological characteristics and survival of primary malignant melanoma of the esophagus. Oncol Lett 2019; 18:1872-1880. [PMID: 31423256 PMCID: PMC6614672 DOI: 10.3892/ol.2019.10519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022] Open
Abstract
Primary malignant melanoma of the esophagus (PMME) has been reported to be a rare and highly malignant disease, and to date a standard treatment strategy has not been established due to limited evidence. The aim of the present study was to investigate the clinicopathological characteristics of this extremely rare disease. A total of 6 out of 2,093 patients with PMME treated in our institution between 1995 and 2016 were retrospectively analyzed and their clinicopathological parameters including treatment course and long-term survival were investigated. The major clinicopathological characteristics of patients were that they were >70 years of age, male sex, dysphagia at first diagnosis, and macroscopic black protruding tumors located in the lower third of the thoracic esophagus. Four of the five patients receiving pretherapeutic endoscopic biopsy were correctly diagnosed with PMME, and two patients received preoperative treatment with ineffective histopathological responses. There were two unresectable cases, one was treated with an immune-checkpoint inhibitor and the other received palliative care. Three of the four patients receiving curative surgery developed hematogenous recurrence within two years of surgery and only one patient with pT1aN0M0 achieved long-term survival. The median overall survival of all six patients was 19.6 (6.4–40.5) months. Patients with stage I disease exhibited significantly more favorable prognoses than those with stage II–IV (P=0.025) and surgically-treated patients had significantly better prognoses than those who did not receive surgery (P=0.018). In conclusion, PMME was associated with highly malignant features and tended to develop hematogenous metastases even after radical resection. Early diagnosis appears to be important to cure this refractory disease.
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Affiliation(s)
- Tadayoshi Hashimoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Eiichi Morii
- Department of Pathology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
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A case of primary malignant melanoma of the esophagus with a widely expanded surface area. Clin J Gastroenterol 2019; 12:424-428. [PMID: 30887427 DOI: 10.1007/s12328-019-00961-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Primary malignant melanoma of the esophagus (PMME) is rare but aggressive. PMME accounts for approximately 0. 1% of all malignant esophageal neoplasms occurring worldwide, and is usually diagnosed during the advanced stage. A 67-year-old man underwent an esophagogastroduodenoscopy (EGD) at our hospital and confirmed 20 mm of black pigmentation in the lower esophagus in the chest area. Pathological biopsy findings of the black-pigmented epithelial tissue revealed the presence of tumor cells with brown granules, leading to the diagnosis of malignant melanoma. Owing to difficulty in accurately diagnosing the range in this PMME case, we performed thoracoscopic esophagectomy. Pathological organisation test results were pT1a-LPM, INFb, pN0, and pM0, which were diagnosed at pStage I. The lesion expanded extensively, measuring > 10 cm in diameter. The tumor cells, which were centrally located in the black-pigmented area, were observed to have proliferated beyond the surrounding brownish area into the mucosa, but no findings were found in the endoscopic examination. As in this case, because PMME may diffusely spread along the basal layer outside the range of pigmentation, endoscopic diagnosis of the extent of disease spread may be impossible; hence, it is important to keep this phenomenon in mind while performing resection to treat PMME.
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Li J, Liu Y, Wang B, Sun X, Meng X. Malignant melanoma of the esophagus complicated with poorly differentiated mucinous adenocarcinoma of the stomach: A case report. Medicine (Baltimore) 2019; 98:e14783. [PMID: 30855489 PMCID: PMC6417549 DOI: 10.1097/md.0000000000014783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary malignant melanoma of the esophagus (PMME) is a rare malignancy that only accounts for <2% of all primary esophageal tumors. Here, we report the even rarer occurrence of PMME in combination with poorly differentiated mucinous adenocarcinoma of the stomach. PATIENT CONCERNS A 64-year-old man was presented to the hospital with >1 month of eating dysphagia. Enhanced computed tomography (CT) scan only found a space-occupying lesion in the lower esophagus with moderate enhancement. However, gastroscope showed not only esophageal masses, but also gastric mucosa changes. DIAGNOSES Poorly differentiated mucinous adenocarcinoma and PMME were diagnosed based on pathological biopsy and immunohistochemical methods. INTERVENTIONS The patient underwent laparoscopic gastric cancer radical surgery, esophageal resection, and colonic replacement of the esophagus. OUTCOMES Abdominal CT and esophagography performed 1 week after surgery showed that it was consistent with postoperative changes without other abnormalities. However, the patient died 3 months after discharge without receiving any other treatment. LESSONS This case suggests more attention should be drawn to the diagnosis of multiple primary malignant neoplasms in elder patients, and also highlights the need to fulfill comprehensive examinations before surgery in case of misdiagnosis. Besides, it is challenging to finding a reasonable treatment for such rare condition.
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Affiliation(s)
- Ji Li
- Department of Gastroenterology
| | - Yan Liu
- Department of Gastroenterology
| | - Bin Wang
- Department of Infectious Disease
| | - Xun Sun
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Koga N, Kubo N, Saeki H, Sasaki S, Jogo T, Hirose K, Nakashima Y, Oki E, Koga Y, Oda Y, Oiwa H, Oiwa T, Maehara Y. Primary amelanotic malignant melanoma of the esophagus: a case report. Surg Case Rep 2019; 5:4. [PMID: 30635729 PMCID: PMC6329688 DOI: 10.1186/s40792-019-0564-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background Primary amelanotic malignant melanoma of esophagus, which is a subtype of primary malignant melanoma of the esophagus (PMME), is a very rare disease with a poor prognosis. We herein report a case of the amelanotic type of PMME. Case presentation An 86-year-old woman was admitted to our hospital with symptoms of dysphagia. An endoscopic examination and constructed radiography revealed an elevated and semipedunculated lesion with an ulcer in the lower thoracic esophagus accompanied by another submucosal lesion of the esophagus. She was diagnosed with esophageal squamous cell carcinoma by a preoperative endoscopic biopsy. We performed thoracoscopy- and laparoscopy-assisted subtotal esophagectomy with lymphadenectomy. Based on the surgical specimens, although there were no melanocytes, we made a diagnosis of a malignant melanoma immunohistochemically; the tumor cells were positive for S-100 protein and HMB45 focally and partially for Melan-A. Conclusion We experienced a case of primary amelanotic malignant melanoma, and the patient has remained disease-free for 1 year since the surgery. Since the diagnosis of amelanotic type of PMME is difficult, it should be made by the combination of a morphological examination, pathological examination, and immunohistochemistry.
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Affiliation(s)
- Naomichi Koga
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuhide Kubo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shun Sasaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoko Jogo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kosuke Hirose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yutaka Koga
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hisao Oiwa
- Oiwa Gastrointestinal Clinic, 2-1-5, Hanami-Higashi, Koga-shi, Fukuoka, 811-3112, Japan
| | - Toshio Oiwa
- Oiwa Gastrointestinal Clinic, 2-1-5, Hanami-Higashi, Koga-shi, Fukuoka, 811-3112, Japan
| | - Yoshihiko Maehara
- Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minami-ku, Fukuoka, 815-8588, Japan
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12
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Sun H, Gong L, Zhao G, Zhan H, Meng B, Yu Z, Pan Z. Clinicopathological characteristics, staging classification, and survival outcomes of primary malignant melanoma of the esophagus. J Surg Oncol 2017; 117:588-596. [PMID: 29266237 DOI: 10.1002/jso.24905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary malignant melanoma of esophagus (PMME) is a remarkably rare and highly aggressive tumor. Studies related with clinicopathological findings, staging classification, and clinical outcomes are lacking. METHODS We reviewed 21 cases of PMME at the Tianjin Medical University Cancer Institute and Hospital from January 2002 to February 2017. RESULTS Nineteen patients (90.48%) presented a history of dysphagia for months, and two (9.52%) experienced retrosternal pain. Histologically, tumors were composed of atypical melanocytes with melanocytosis surrounding the tumor. The overall survival was 1-40 months, with the median time of 10 months. The mucosal staging classification for upper aerodigestive tract showed better distribution of overall survival with different stages than that of the American Joint Commission on Cancer staging classification for esophagus, but without statistical difference. Both the clinical and pathological characteristics were not highly consistent with overall survival. CONCLUSIONS PMME is a considerably aggressive tumor with poor prognosis. The staging classification of mucosal melanoma of the upper aerodigestive tract may be a good option for PMME patients.
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Affiliation(s)
- Haiyan Sun
- Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Gang Zhao
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Hongdian Zhan
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Bin Meng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Zhanyu Pan
- Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
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Kuwabara S, Ebihara Y, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Primary malignant melanoma of the esophagus treated with subtotal esophagectomy: a case report. BMC Surg 2017; 17:122. [PMID: 29197361 PMCID: PMC5712089 DOI: 10.1186/s12893-017-0326-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis. There are few reports of early-stage cases in which tumor invasion reached the lamina propria or muscularis mucosae, as in the present case. A standard treatment for early-stage PMME has not yet been established. The present study aimed to summarize previous reports and to discuss the indications for surgical treatment of early-stage primary malignant melanoma of the esophagus. CASE PRESENTATION A 70-year-old woman with PMME was referred to our hospital. She underwent thoracoscopic and laparoscopic subtotal esophagectomy with lymphadenectomy. The resected specimen showed melanocytosis and junctional activity. Melanoma-specific antigens melan-A, S-100, and HMB45 were detected by immunohistochemical staining. The pathological diagnosis was pT1a-MM, pN0, pM0, and pStage IA. She remains alive without evidence of recurrence 39 months later. CONCLUSION Subtotal esophagectomy with regional radical lymphadenectomy could be recommended to patients with early-stage primary malignant melanoma of the esophagus, and curative surgical resection could improve their prognosis.
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Affiliation(s)
- Shota Kuwabara
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
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14
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Zhao T, Kong FW, Wang H, Liu D, Wang CY, Luo JH, Zhang M, Wu WB. A long-term survivor with esophageal melanoma and pulmonary metastasis after single-stage esophagectomy and lobectomy: Case report and literature review. Medicine (Baltimore) 2017; 96:e7003. [PMID: 28538413 PMCID: PMC5457893 DOI: 10.1097/md.0000000000007003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE The optimal therapeutic regimen for primary malignant melanoma of the esophagus (PMME) need to be further elucidated. Besides, the efficacy of surgery for PMME with remote metastasis is uncertain for its rarity. PATIENT CONCERNS Herein a previously healthy patient was admitted for dysphagia and fatigue, without significant weight loss. DIAGNOSES The pathological and molecular tests revealed his diagnosis of BRAF-mutant, advanced PMME with localized pulmonary metastasis. INTERVENTIONS Single-stage Ivor-Lewis esophagectomy and lobectomy were performed successfully, followed by 4 cycles of conventional chemotherapy, and concurrent high-dose interferon lasting for 1 year. OUTCOMES The patient survived without logo-regional recurrence or remote metastasis during the follow up of two and a half years up to now. LESSONS Timely resection of localized primary and metastatic lesions might deliver a chance to obtain better prognosis for selected PMME patients; however, high-quality trials with longer follow-up are needed.
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Affiliation(s)
- Tian Zhao
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University
| | - Feng-Wei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Heng Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University
| | - Dong Liu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University
| | - Chun-Ying Wang
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Jin-Hua Luo
- Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University
| | - Wen-Bin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University
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15
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Abstract
OBJECTIVE The purpose of this article is to summarize the epidemiologic characteristics, clinical aspects, and radiologic appearance of as well as the management considerations and differential diagnoses for noncutaneous primary melanomas occurring at specific anatomic sites. Primary ocular, sinonasal, meningeal, biliary, adrenal, alimentary tract, and genitourinary melanomas are highlighted. CONCLUSION Noncutaneous primary melanomas are a complex group of malignancies with biologic findings that are unique when compared with findings for cutaneous melanomas. Each noncutaneous primary melanoma has its own specific diagnostic and management challenges, depending on the anatomic location where they arise.
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16
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Weiner JP, Shao M, Schwartz D, Wong A, Schreiber D. Patterns of care and survival outcomes in the treatment of esophageal melanoma. Dis Esophagus 2017; 30:1-6. [PMID: 27862623 DOI: 10.1111/dote.12504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Because of the rarity of esophageal melanoma, the optimal management of this disease is limited. The pooled dataset in the National Cancer Database (NCDB) was used to identify the prognostic factors and treatment outcomes. Patients who were diagnosed with esophageal melanoma between 2004 and 2011 were identified. Patients were stratified as either localized (T1-4N0M0), regional (T1-4N+M0), or metastatic (M1). The primary endpoint of this study was overall survival (OS) which was analyzed using the Kaplan-Meier method and multivariate Cox regression, which was performed to identify potential factors influencing survival. A total of 56 patients were identified with median follow-up of 10.2 months. Twenty-seven (48.2%) patients had localized disease, 10 patients (17.9%) had regional disease, and 19 patients (33.9%) were metastatic at diagnosis. For those with localized disease, the 3 year OS was 50.5% for the 14 patients treated with esophagectomy, and 0.0% for the seven treated with definitive radiation therapy. For regional disease, the 3 year OS was 11.1% for the nine patients treated with esophagectomy. The 3 year OS for those with metastatic disease at diagnosis was 0.0%. On multivariate analysis, treatment with esophagectomy was not associated with a reduced risk of death (HR 0.84, 95% CI 0.31-2.25, P = 0.73), while regional disease (HR 3.78, 95% CI 1.40-10.19, P = 0.009) and metastatic disease (HR 7.54, 95% CI 2.89-19.62, P < 0.001) were associated with decreased survival. Esophageal melanoma is an extremely rare and aggressive disease with very poor outcomes. Esophagectomy may result in reasonable survival for localized disease.
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Affiliation(s)
- Joseph P Weiner
- VA NY Harbor Healthcare System Brooklyn Campus, Radiation Oncology.,State University of New York Downstate Medical Center, Radiation Oncology, Brooklyn, New York, USA
| | - Meng Shao
- VA NY Harbor Healthcare System Brooklyn Campus, Radiation Oncology.,State University of New York Downstate Medical Center, Radiation Oncology, Brooklyn, New York, USA
| | - David Schwartz
- VA NY Harbor Healthcare System Brooklyn Campus, Radiation Oncology.,State University of New York Downstate Medical Center, Radiation Oncology, Brooklyn, New York, USA
| | - Andrew Wong
- VA NY Harbor Healthcare System Brooklyn Campus, Radiation Oncology.,State University of New York Downstate Medical Center, Radiation Oncology, Brooklyn, New York, USA
| | - David Schreiber
- VA NY Harbor Healthcare System Brooklyn Campus, Radiation Oncology.,State University of New York Downstate Medical Center, Radiation Oncology, Brooklyn, New York, USA
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17
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Wang M, Chen J, Sun K, Zhuang Y, Xu F, Xu B, Zhang H, Li Q, Zhang D. Primary malignant melanoma of the esophagus treated by endoscopic submucosal dissection: A case report. Exp Ther Med 2016; 12:1319-1322. [PMID: 27602062 PMCID: PMC4998296 DOI: 10.3892/etm.2016.3482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/18/2016] [Indexed: 12/13/2022] Open
Abstract
Primary malignant melanoma of the esophagus (PMME) is a rare malignant neoplasm of the esophagus. In the majority of cases, the disease originates in the mucosal layer of the esophagus, which is similar to other types of esophageal cancer. With the development of endoscopic submucosal dissection (ESD), endoscopic resection is possible for cases in which melanomas are limited to the mucosal and submucosal layer. However, few studies report the efficiency of ESD for PMME, and no studies perform long-term follow-up. The present study reported the case of a 71-year-old PMME patient who was successfully treated by ESD at The Third Affiliated Hospital of Soochow University (Changzhou, China) in Otober 2011, with a follow-up of >3 years conducted.
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Affiliation(s)
- Mei Wang
- Department of Digestion, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Jianping Chen
- Department of Digestion, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Kewen Sun
- Department of Digestion, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Yun Zhuang
- Department of Digestion, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Fu Xu
- Department of Digestion, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Bin Xu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Hongyu Zhang
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Qing Li
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Dachuan Zhang
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
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18
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Harada K, Mine S, Yamada K, Shigaki H, Oya S, Baba H, Watanabe M. Long-term outcome of esophagectomy for primary malignant melanoma of the esophagus: a single-institute retrospective analysis. Dis Esophagus 2016; 29:314-9. [PMID: 25708974 DOI: 10.1111/dote.12331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary malignant melanoma of the esophagus (PMME) is a highly malignant tumor with a poor prognosis. Because PMME is an extremely rare disease, therapeutic strategies against the tumor have yet to be established, and the efficacy of esophagectomy remains unclear. The objective of this study was to evaluate the post-esophagectomy survival of PMME patients. Ten patients who underwent esophagectomy for PMME between March 2005 and April 2013 at the Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan, were identified from the institutional database. We retrospectively retrieved clinical information and data on the long-term outcomes from the patients' records. Survival rates after esophagectomy were calculated by the Kaplan-Meier method, and the hazard ratios of mortality were determined using the Cox's model. A follow-up study of the 10 patients revealed 7 cancer recurrences and 5 deaths. Median survival time was 34.5 months, and 5 of 10 patients survived longer than 2 years. The 1-year disease-free survival rate was 40%, and the 1- and 3-year overall survival rates were 70% and 60%, respectively. Importantly, all three of the non-relapsing patients were histologically confirmed as free of lymph node involvement. The four patients with lymph node metastasis relapsed within 1 year. The disease-free survival was significantly shorter in patients with lymph node involvement than in those without lymph node involvement (univariate hazard ratio = 13.3, 95% confidence interval 1.85-266.4; P = 0.009). In conclusion, esophagectomy might benefit PMME patients with no lymph node metastasis. Further large-scale cohort studies are needed to establish the treatment strategy for PMME.
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Affiliation(s)
- K Harada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - S Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - K Yamada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - H Shigaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - S Oya
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
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19
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Characteristics and Surgical Outcomes for Primary Malignant Melanoma of the Esophagus. Sci Rep 2016; 6:23804. [PMID: 27033424 PMCID: PMC4817120 DOI: 10.1038/srep23804] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/02/2016] [Indexed: 12/27/2022] Open
Abstract
Primary malignant melanoma of the esophagus (PMME) is an extremely rare disease with poor prognosis. We summarized and analyzed the characteristics of 17 PMME patients (with average age of 57.5 ± 10.3 years) who had received surgical resection in our center. The majority (13/17, 76.5%) of the patients were male. The percentage of patients with smoking and alcohol consumption was 41.2% and 23.5%, respectively. The preoperative diagnosis rate was 35.3%. Lymph node metastasis mainly involved the mid-lower mediastinal and upper abdominal area. Primary tumors that invaded beyond the submucosa layer (T2–T4) had much higher tendency of lymph node metastasis than those restricted to the submucosa layer (T1) (6/8, 75.0% vs. 3/9, 33.3%, p = 0.086). The 1-year and 5-year survival rate of the patients was 51% and 10%, respectively, with median survival time being 18.1 months. Survival analysis showed that TNM stage was a predictor for PMME prognosis (median survival time of 47.3 months vs. 8.0 months for stage I/II vs. stage III, respectively, p = 0.018), and multivariable Cox regression analysis revealed the independence of its prognostic value [HR (95% CI): 5.678 (1.125–28.658), p = 0.035].
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20
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21
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Zhang L, Ma W, Li Y. Huge primary malignant melanoma of the esophagus: A case report and literature review. Thorac Cancer 2013; 4:479-483. [PMID: 28920227 DOI: 10.1111/1759-7714.12063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022] Open
Abstract
Primary malignant melanoma of the esophagus (PMME) is a relatively rare esophageal malignancy accounting for 0.1-0.2% of all esophageal tumors. Because the tumor cells occur mainly in the esophagus mucosa and grow along the longitudinal axis in the lumen, it causes relatively late obstruction symptoms, even though the lesion is a much larger mass than found in most cases of esophagus carcinoma, protruding into the esophageal lumen. Invasive growth results in stenosis, followed by difficulty eating. A patient may not be aware of their illness until transesophageal endoscopic biopsy or postoperative pathology is confirmed. Positive expression of immunohistochemical markers human melanoma black (HMB) 45 and S-100, are the most important factors in confirming diagnosis. Because of the high degree of malignancy and the poor prognosis of PMME, upon diagnosis total or subtotal esophagectomy plus three-field systemic lymph node dissection with incisions in the left cervical, right chest, and superior belly, is critically required. In summary, early diagnosis and expanding esophageal resection may be the best approach to prevent local recurrence and distant metastasis.
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Affiliation(s)
- Lin Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wei Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yun Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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22
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Suárez Aliaga B, Fernández Fernández S. Melanoma primario multicéntrico de esófago. RADIOLOGIA 2013; 55:457-8. [DOI: 10.1016/j.rx.2011.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 12/22/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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23
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Morita FHA, Ribeiro U, Sallum RAA, Tacconi MR, Takeda FR, da Rocha JRM, Ligabó GDSC, de Melo ES, Pollara WM, Cecconello I. Primary malignant melanoma of the esophagus: a rare and aggressive disease. World J Surg Oncol 2013; 11:210. [PMID: 23972096 PMCID: PMC3765877 DOI: 10.1186/1477-7819-11-210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 08/04/2013] [Indexed: 11/12/2022] Open
Abstract
Primary malignant melanoma of the esophagus is an uncommon tumor, with approximately 300 cases having been reported thus far. The purpose of this study was to describe a case of a 60 year-old man with a 10 month history of progressive dysphagia and thoracic pain, the investigations of which led to a diagnosis of primary malignant melanoma of the esophagus. The patient underwent a transhiatal esophagectomy with subcarinal lymphadenectomy, and isoperistaltic gastric tube replacement of the esophagus. Nine months after surgery, he developed ischemic colitis, and metastasis in the mesentery was diagnosed. His disease progressed and he died one year after the esophagectomy. A review of the literature was performed.
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Affiliation(s)
- Flávio Hiroshi Ananias Morita
- Departments of Gastroenterology/Pathology, Instituto do Câncer do Estado de São Paulo - ICESP, University of São Paulo School of Medicine, São Paulo, Brazil.
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24
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Wang S, Tachimori Y, Hokamura N, Igaki H, Kishino T, Kushima R. Diagnosis and surgical outcomes for primary malignant melanoma of the esophagus: a single-center experience. Ann Thorac Surg 2013; 96:1002-6. [PMID: 23810175 DOI: 10.1016/j.athoracsur.2013.04.072] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND We summarize the experience of diagnosis and surgical therapy for primary malignant melanoma of the esophagus (PMME). METHODS Clinical data of 13 patients diagnosed as having PMME treated by surgery as their primary therapy from 2000 to 2012 were retrospectively analyzed, and survival information was collected through follow-up. RESULTS The average age (±standard deviation) of participants in this study was 66.4±7.6 years, and 84.6% were male. Overall, 61.5% of tumors were located in the lower thoracic esophagus. The accuracies of clinical T stage, N stage, and TNM stage were 53.9%, 46.2%, and 38.5%, respectively, compared with pathological staging (kappa=0.252, p=0.023). Surgical mortality and morbidity were 7.7% and 53.9%, respectively. The incidence of lymph node metastasis for patients with tumor invading within the mucosa was 0, but increased to 42.9% (3 of 7) with tumor invading to the submucosal layer. Primary malignant melanoma of the esophagus in the mid third of the thoracic esophagus had a greater chance to metastasize to perigastric lymph nodes (2 of 5) than to middle mediastinal lymph nodes (1 of 5). For PMME located at the lower third of the thoracic esophagus, upper mediastinal lymph node metastasis was more likely to occur (2 of 4) with tumor invasion penetrating the proper muscle layer. Recurrence occurred within 1 year in all patients with tumor later than Stage Ib. The most common recurrent organ was the liver. The overall 1-year and 5-year postoperative survival rates were 54.0% and 35.9%, respectively, and lymph node metastasis was the independent predictive factor for postoperative survival (p=0.013; odds ratio, 15.05). CONCLUSIONS Despite the similarity in lymph node metastatic patterns to squamous cell carcinoma, PMME is more inclined to distant metastasis. Clinical staging was inconsistent with pathological staging for PMME based on endoscopy and computed tomography. Surgical therapy was the optimal treatment for PMME at an earlier stage. Early diagnosis and aggressive lymph node dissection were beneficial for accurate staging, potentially reducing recurrence and thus improving survival.
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Affiliation(s)
- Shaohua Wang
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
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25
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Primary multifocal malignant melanoma of the esophagus. J Gastrointest Cancer 2013; 45:228-30. [PMID: 23636863 DOI: 10.1007/s12029-013-9503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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