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Zhu ML, Wang LY, Bai XQ, Wu C, Liu XY. Primary malignant melanoma of the esophagus combined with squamous cell carcinoma: A case report. World J Gastrointest Surg 2023; 15:287-293. [PMID: 36896304 PMCID: PMC9988636 DOI: 10.4240/wjgs.v15.i2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Primary malignant melanoma of the esophagus is a rare malignant tumor of the esophagus, and its combination with squamous cell carcinoma is also rare. Here, we report the diagnosis and treatment of a case of primary esophageal malignant melanoma combined with squamous cell carcinoma.
CASE SUMMARY A middle-aged man underwent gastroscopy for dysphagia. Gastroscopy revealed multiple bulging esophageal lesions, and after pathologic and immunohistochemical analyses, the patient was finally diagnosed with "malignant melanoma with squamous cell carcinoma". This patient received comprehensive treatment. After one year of follow-up, the patient was in good condition, and the esophageal lesions seen on gastroscopy were controlled, but unfortunately, liver metastasis occurred.
CONCLUSION When multiple esophageal lesions are present, the possibility of multiple pathological sources should be considered. This patient was diagnosed with primary esophageal malignant melanoma combined with squamous cell carcinoma.
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Affiliation(s)
- Mei-Lin Zhu
- Department of Geriatrics, Jining No. 1 People's Hospital, Jining 272000, Sahndong Province, China
| | - Ling-Yun Wang
- Department of Gastroenterology, Jining No. 1 People's Hospital, Jining 272000, Shandong Province, China
| | - Xue-Qin Bai
- Department of Pathology, Jining No. 1 People's Hospital, Jining 272000, Sahndong Province, China
| | - Chen Wu
- Department of Gastroenterology, Jining No. 1 People's Hospital, Jining 272000, Shandong Province, China
- College of Clinical Medicine, Jining Medical University, Jining 272013, Shandong Province, China
| | - Xiang-Yu Liu
- Department of Gastroenterology, Jining No. 1 People's Hospital, Jining 272000, Shandong 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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Zhang RX, Li YY, Liu CJ, Wang WN, Cao Y, Bai YH, Zhang TJ. Advanced primary amelanotic malignant melanoma of the esophagus: A case report. World J Clin Cases 2019; 7:3160-3167. [PMID: 31624769 PMCID: PMC6795737 DOI: 10.12998/wjcc.v7.i19.3160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary malignant melanoma of the esophagus accounts for 0.1%-0.2% of all esophageal malignancies, including melanotic and amelanotic melanomas. Primary amelanotic malignant melanoma of the esophagus is extremely rare, and only about 20 cases have been published in the literature to date. Most primary malignant melanomas of the esophagus are diagnosed following development of metastatic lesions and thus have a very poor prognosis. The median survival duration of patients with metastatic melanoma has been reported to be 6.2 mo.
CASE SUMMARY A 49-year-old woman was referred to our hospital with a diagnosis of esophageal cancer. Endoscopy, biopsy, imaging evaluation, and physical examination at our hospital indicated a diagnosis of advanced primary amelanotic malignant melanoma of the esophagus. Immunohistochemical staining confirmed melanoma. Nuclear medicine examination revealed a left iliac bone metastatic lesion. After discharge, the patient self-administered apatinib for 3 mo, followed by oral treatment with Chinese medicines (also self-administered) for 2 mo. No treatments had been taken since then. The patient has survived with no growth out to the most recent follow-up (24 mo post diagnosis), and she always presented with a positive attitude about her condition during this period.
CONCLUSION Survival following metastatic melanoma might be related to the pharmaceutical and Chinese medicine treatment and the patient's positive attitude.
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Affiliation(s)
- Ruo-Xi Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Ya-Ying Li
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Chang-Jie Liu
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Wei-Na Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Cao
- Department of Pathology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Yong-Hua Bai
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Ti-Jiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Rochefort P, Roussel J, de la Fouchardière A, Sarabi M, Desseigne F, Guibert P, Cattey-Javouhey A, Mastier C, Neidhardt-Berard EM, de la Fouchardière C. Primary malignant melanoma of the esophagus, treated with immunotherapy: a case report. Immunotherapy 2019; 10:831-835. [PMID: 30073896 DOI: 10.2217/imt-2018-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary malignant melanoma of the esophagus is rare, accounting for less than 0.1-0.2% of all esophageal malignancies. It is associated with a poor outcome due to late detection and high metastatic potential. Here, we report a case of esophageal cancer, which was initially diagnosed as an adenocarcinoma and finally was confirmed as a primary malignant melanoma. This 75-year-old Caucasian male had a history of dysphagia and recent lingering abdominal pain. First biopsy showed a poorly-differentiated adenocarcinoma. He was then treated with neoadjuvant radiochemotherapy. Biopsies were repeated because of an incomplete tumor response, evaluated by endoscopic and imaging studies. The final diagnosis was a malignant melanoma. The patient has been treated with immune-checkpoint inhibitor, nivolumab, an anti-PD1 antibody.
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Affiliation(s)
- Pauline Rochefort
- Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | - Juliette Roussel
- Department of Biopathology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | | | - Matthieu Sarabi
- Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | - Françoise Desseigne
- Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | - Pierre Guibert
- Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | - Anne Cattey-Javouhey
- Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France
| | - Charles Mastier
- Departement of Radiology, Centre Leon Berard, Claude Bernard University, Lyon, France
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Ahsan BU, Alhamar M, Pompa R, Schultz D, Zhang Z. Metastatic malignant melanoma of the oesophagus, first case diagnosed by endoscopic ultrasound-guided fine needle aspiration. Cytopathology 2019; 30:538-540. [PMID: 30980784 DOI: 10.1111/cyt.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Beena U Ahsan
- Department of Pathology & Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Mohamed Alhamar
- Department of Pathology & Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Robert Pompa
- Department of Gastroenterology, Henry Ford Hospital, Detroit, Michigan
| | - Daniel Schultz
- Department of Pathology & Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Ziying Zhang
- Department of Pathology & Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan
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Abstract
PURPOSE OF REVIEW Mucosal melanoma is of great interest due to its aggressive behavior and less favorable prognosis. The literature is mainly case reports and case series. Here, we will collect the knowledge on mucosal melanoma from the last decade and review the literature. The main focus is being site-specific clinical features, treatment, and prognosis. RECENT FINDINGS The use of immunotherapy gain ground as for others subsets of melanoma. Anti-CTLA-4 and anti-PD-1/ PD-L1 blockade in mucosal melanoma have been evaluated in recent studies. Clinical trials are ongoing. The etiology of mucosal melanomas remains unknown. Head and neck mucosal melanomas are most common. Wide excision surgery is the treatment of choice. The effect of adjuvant therapy on survival remains questionable due to the limited knowledge. Radiotherapy seems to give better local control. The overall five-year survival rate for mucosal melanomas is 0-45%. Recent data indicates that this may be improved by the immunotherapy in the years to come.
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Affiliation(s)
- Simon Skovsted Yde
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark.
| | - Pia Sjoegren
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Martin Heje
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Lars B Stolle
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
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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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8
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Liang ZP, Xu SE, Jiang L, Zhao C, Sun XQ, Qin G. Scalp junctional nevus with malignant transformation (melanoma) metastatic to parotid lymph node region, cervical lymph nodes and the back: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:954-959. [PMID: 25755802 PMCID: PMC4348854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
Parotid malignancy may occur as a primary neoplasm of the salivary tissue or as metastatic involvement of the parotid lymph nodes. Primary tumors of squamous cell carcinoma and malignant melanoma involving the skin of the head and neck have the potential to spread to lymph nodes of the parotid gland. Metastatic malignant melanoma to the back was exceptionally rare and no such reports have been noted in the literature. We reported an exceptional case of intraparotid lymph nodes metastasis of the right scalp junctional nevus with malignant transformation to malignant melanoma in a 48-year-old man. The patient presented with a mass in the parotid gland area, which was misdiagnosed as a primary parotid tumor and surgical removal was performed. Unfortunately, recurrence with newly developed metastatic lesions in the back and cervical lymph nodes occurred 1 year after initial surgical management. This case is presented highlighting the unusual features of metastatic junctional nevus with malignant transformation to malignant melanoma of intraparotid lymph nodes, cervical lymph nodes and the back, which should help us to reduce misdiagnosis and obtain the best results.
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Affiliation(s)
- Zhuo-Ping Liang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
| | - Sheng-En Xu
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
| | - Liang Jiang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
| | - Chong Zhao
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
| | - Xiao-Qiang Sun
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
| | - Gang Qin
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Luzhou Medical College Luzhou, Sichuan Province, China
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A clinicopathological analysis of primary mucosal malignant melanoma. Surg Today 2014; 45:886-91. [DOI: 10.1007/s00595-014-1041-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/10/2014] [Indexed: 02/07/2023]
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10
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Zheng J, Mo H, Ma S, Wang Z. Clinicopathological findings of primary esophageal malignant melanoma: report of six cases and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:7230-7235. [PMID: 25400820 PMCID: PMC4230078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/13/2014] [Indexed: 06/04/2023]
Abstract
We studied images and histopathological features of primary esophageal malignant melanoma to explore the clinical pathological features, diagnosis, differential diagnoses, and treatment. Immunolabelling was conducted on six cases of esophageal malignant melanoma using histological and immunohistochemical techniques. Combined with the related literature, the clinical manifestations, imaging, histopathological and immunohistochemical features, treatment, and prognosis of primary esophageal malignant melanoma were observed and analyzed. The six patients with primary esophageal malignant melanoma were all male with an average age of 63.4 years. Poor food intake was observed in all patients, and the symptoms showed progressive aggravation. Endoscopic feed tube revealed dark brown and black nodular and polypoid lesions, 1/4-1/2 loop cavity. Tumor histopathology revealed the following characteristics: tumor cells arranged in nests, sheets and cords, round or polygonal, abundant and red-stained cytoplasm, melanin granules in the cytoplasm, heterogeneous nucleus sizes, centered or deviated nuclei, clearly identifiable nucleoli, and apparent pathological mitosis. The immune phenotype was as follows: tumor cells had diffuse expression of HMB45, Melan A, and S100. The cells were CK negative, and the Ki67-positive cell number was 40%-45%. Primary esophageal malignant melanoma is rare with high malignancy and poor prognosis. Immunohistochemical staining is helpful for diagnosing this tumor. The differential diagnosis includes low differentiated carcinoma, primitive neuroectodermal tumor, esophageal sarcomatoid carcinoma, esophageal lymphoma, and other tumors.
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Affiliation(s)
- Jinfeng Zheng
- Department of Pathology, The General Hospital, Jinan Military CommandJinan 250031, China
| | - Haiying Mo
- Department of Pathology, Zaozhuang Hospital of Zaozhuang Mining GroupZaozhuang 277100, China
| | - Shufang Ma
- Department of Community, The Fifth Hospital of Jinan CityJinan 250022, China
| | - Zhenzheng Wang
- Department of Pathology, 456 Hospital of PLAJinan 250031, China
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Lazarou I, Purek L, Duc C, Licker MJ, Spiliopoulos A, Tschopp JM. Primary malignant achromic melanoma of the lung. Thorac Cancer 2014; 5:85-8. [PMID: 26766979 DOI: 10.1111/1759-7714.12011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 11/13/2012] [Indexed: 01/13/2023] Open
Abstract
Currently, less than thirty cases of primary malignant melanoma of the lung have been reported in the literature. Thus, strict criteria for diagnosis have been published and include: malignant melanoma associated with bronchial epithelial changes; a solitary lung tumor; no prior history of skin, mucous membrane, intestinal or ocular melanoma; and absence of any other detectable tumor at the time of diagnosis. In this article we present a case of melanoma of the lung without evidence of extra-pulmonary disease.
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Affiliation(s)
- Ilias Lazarou
- Centre Valaisan de Pneumologie - Réseau Santé Valais Crans-Montana, Switzerland
| | - Lesek Purek
- Centre Valaisan de Pneumologie - Réseau Santé Valais Crans-Montana, Switzerland
| | - Christophe Duc
- Histocytopathologie, Institut Central ICHV Sion, Switzerland
| | | | | | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie - Réseau Santé Valais Crans-Montana, Switzerland
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12
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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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