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Amelanotic esophageal malignant melanoma: case report and short review of the literature.

Kranzfelder M, Seidl S, Dobritz M, BrĂ¼cher BL - Case Rep Gastroenterol (2008)

Bottom Line: Two months postoperatively, the planning CT scan for radiotherapy revealed progression of the retroperitoneal tumor mass, which was enclosing the celiac trunk, renal vein, and superior mesenteric artery.Multiple new liver and lung metastases were also found.At the end of May 2007, 4 months after the primary diagnosis, the patient died due to acute renal failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Technical University of Munich, Munich.

ABSTRACT
Malignant melanoma in the esophagus is a rare condition which has been described only occasionally in case reports or in larger series of patients with esophageal disease. We describe here the very rare case of a patient who presented initially with a 2-month history of dysphagia and weight loss which led to the endoscopic diagnosis of an unclear lesion in the distal esophagus. Biopsies were taken revealing positive immunohistochemical staining against HMB-45. As there were no signs of skin melanoma and there was an absence of pigmentation, a diagnosis of primary amelanotic malignant melanoma was made. Primary staging of the lesion was completed with computed tomography (CT), which revealed a locally advanced tumor with lymph node metastases at the lesser curvature of the stomach and celiac trunk. As there is still a lack of potential protocols for multimodal neoadjuvant treatment for this rare tumor entity, a palliative abdominothoracic esophagectomy with systemic lymphadenectomy and intrathoracic anastomosis was carried out. Due to an intraoperative R2 situation, clip marking was performed to allow postoperative radiotherapy. Two months postoperatively, the planning CT scan for radiotherapy revealed progression of the retroperitoneal tumor mass, which was enclosing the celiac trunk, renal vein, and superior mesenteric artery. Multiple new liver and lung metastases were also found. During the following weeks, the patient developed acute renal failure and was admitted for dialysis, and the planned radiotherapy was deferred. At the end of May 2007, 4 months after the primary diagnosis, the patient died due to acute renal failure.

No MeSH data available.


Related in: MedlinePlus

a Hematoxylin-eosin staining of the tumor, showing polymorphic nuclei, prominent macronucleoli, and mitosis. b Pancytokeratin staining is positive in the overlying epithelium and negative in the tumor. c There is strongly positive staining of the tumor cells for S100. d Positive staining of the tumor cells for HMB-45.
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Figure 3: a Hematoxylin-eosin staining of the tumor, showing polymorphic nuclei, prominent macronucleoli, and mitosis. b Pancytokeratin staining is positive in the overlying epithelium and negative in the tumor. c There is strongly positive staining of the tumor cells for S100. d Positive staining of the tumor cells for HMB-45.

Mentions: Following an interdisciplinary discussion, the decision was taken to carry out a palliative abdominothoracic esophagectomy with systematic lymphadenectomy and with an intrathoracic esophagogastric anastomosis. In addition, abdominal tumor debulking was planned, as well as intraoperative clip marking to allow postoperative radiotherapy, due to the high risk of a macroscopic R2 resection in the area of the celiac trunk. The surgical specimen contained the ulcerative tumor in the distal esophagus and distinct glymph node conglomerates. Neoplastic infiltration included the muscularis propria and marked tumor tissue around the celiac trunk. Histopathology showed tumor cells with highly atypic nuclei, prominent macronucleoli, and high mitosis rates. No pigment was observed in the areas examined. The lymph nodes were macroscopically suspicious for tumor invasion, and histopathology revealed tumor infiltration into the mediastinal lymph nodes (n = 10). Resection of the primary tumor was macroscopically and microscopically complete, while the lymph node conglomerate around the celiac trunk only allowed R2 resection. Immunohistochemical staining was positive for S100 (in contrast to the biopsies) and HMB-45, and was negative for CD45 and pancytokeratin. Histopathology established a diagnosis of amelanotic PMME (fig. 3).


Amelanotic esophageal malignant melanoma: case report and short review of the literature.

Kranzfelder M, Seidl S, Dobritz M, BrĂ¼cher BL - Case Rep Gastroenterol (2008)

a Hematoxylin-eosin staining of the tumor, showing polymorphic nuclei, prominent macronucleoli, and mitosis. b Pancytokeratin staining is positive in the overlying epithelium and negative in the tumor. c There is strongly positive staining of the tumor cells for S100. d Positive staining of the tumor cells for HMB-45.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3037985&req=5

Figure 3: a Hematoxylin-eosin staining of the tumor, showing polymorphic nuclei, prominent macronucleoli, and mitosis. b Pancytokeratin staining is positive in the overlying epithelium and negative in the tumor. c There is strongly positive staining of the tumor cells for S100. d Positive staining of the tumor cells for HMB-45.
Mentions: Following an interdisciplinary discussion, the decision was taken to carry out a palliative abdominothoracic esophagectomy with systematic lymphadenectomy and with an intrathoracic esophagogastric anastomosis. In addition, abdominal tumor debulking was planned, as well as intraoperative clip marking to allow postoperative radiotherapy, due to the high risk of a macroscopic R2 resection in the area of the celiac trunk. The surgical specimen contained the ulcerative tumor in the distal esophagus and distinct glymph node conglomerates. Neoplastic infiltration included the muscularis propria and marked tumor tissue around the celiac trunk. Histopathology showed tumor cells with highly atypic nuclei, prominent macronucleoli, and high mitosis rates. No pigment was observed in the areas examined. The lymph nodes were macroscopically suspicious for tumor invasion, and histopathology revealed tumor infiltration into the mediastinal lymph nodes (n = 10). Resection of the primary tumor was macroscopically and microscopically complete, while the lymph node conglomerate around the celiac trunk only allowed R2 resection. Immunohistochemical staining was positive for S100 (in contrast to the biopsies) and HMB-45, and was negative for CD45 and pancytokeratin. Histopathology established a diagnosis of amelanotic PMME (fig. 3).

Bottom Line: Two months postoperatively, the planning CT scan for radiotherapy revealed progression of the retroperitoneal tumor mass, which was enclosing the celiac trunk, renal vein, and superior mesenteric artery.Multiple new liver and lung metastases were also found.At the end of May 2007, 4 months after the primary diagnosis, the patient died due to acute renal failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Technical University of Munich, Munich.

ABSTRACT
Malignant melanoma in the esophagus is a rare condition which has been described only occasionally in case reports or in larger series of patients with esophageal disease. We describe here the very rare case of a patient who presented initially with a 2-month history of dysphagia and weight loss which led to the endoscopic diagnosis of an unclear lesion in the distal esophagus. Biopsies were taken revealing positive immunohistochemical staining against HMB-45. As there were no signs of skin melanoma and there was an absence of pigmentation, a diagnosis of primary amelanotic malignant melanoma was made. Primary staging of the lesion was completed with computed tomography (CT), which revealed a locally advanced tumor with lymph node metastases at the lesser curvature of the stomach and celiac trunk. As there is still a lack of potential protocols for multimodal neoadjuvant treatment for this rare tumor entity, a palliative abdominothoracic esophagectomy with systemic lymphadenectomy and intrathoracic anastomosis was carried out. Due to an intraoperative R2 situation, clip marking was performed to allow postoperative radiotherapy. Two months postoperatively, the planning CT scan for radiotherapy revealed progression of the retroperitoneal tumor mass, which was enclosing the celiac trunk, renal vein, and superior mesenteric artery. Multiple new liver and lung metastases were also found. During the following weeks, the patient developed acute renal failure and was admitted for dialysis, and the planned radiotherapy was deferred. At the end of May 2007, 4 months after the primary diagnosis, the patient died due to acute renal failure.

No MeSH data available.


Related in: MedlinePlus