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      Amelanotic Esophageal Malignant Melanoma: Case Report and Short Review of the Literature

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          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.

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          Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities.

          Traditionally, surgery is considered the best treatment for oesophageal cancer in terms of locoregional control and long-term survival. However, survival 5 years after surgery alone is about 25%, and, therefore, a multidisciplinary approach that includes surgery, radiotherapy, and chemotherapy, alone or in combination, could prove necessary. The role of each of these treatments in the management of oesophageal cancer is under intensive research to define optimum therapeutic strategies. In this report we provide an update on treatment strategies for resectable oesophageal cancers on the basis of recent published work. Results of the latest randomised trials allow us to propose the following guidelines: surgery is the standard treatment, to be used alone for stages I and IIa, or possibly with neoadjuvant chemotherapy or chemoradiotherapy for stage IIb disease. For locally advanced cancers (stage III), neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is appropriate for adenocarcinomas. Chemoradiotherapy alone should only be considered in patients with squamous-cell carcinomas who show a morphological response to chemoradiotherapy, and produces a similar overall survival to chemoradiotherapy followed by surgery, but with less post-treatment morbidity. Although the addition of surgery to chemotherapy or chemoradiotherapy could result in improved local control and survival, surgery should be done in experienced hospitals where operative mortality and morbidity are low. Moreover, surgery should be kept in mind as salvage treatment in patients with no morphological response or persistent tumour after definitive chemoradiotherapy.
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            Primary malignant melanoma of the esophagus: a case report and review of the literature.

            The purpose of this report is to describe a new case of primary malignant melanoma of the esophagus (PMME) and to review the recent literature. A 75-year-old man underwent an esophagoscopy for a 3-month history of dysphagia and weight loss. A pigmented polypoïd mass in the lower third of esophagus was discovered, identified by biopsy as a malignant melanoma. No pigmented lesions of the skin or eyes were observed and a diagnosis of PMME was made. A total transhiatal esophagectomy was carried out and 12 months after the operation the patient is disease-free. PMME is a rare neoplasm, with only 238 cases having been reported in the literature. Although characterized by an aggressive biological behavior, esophagectomy can result in a 5-year survival rate of up to 37% of cases, whereas chemotherapy, immunotherapy and radiation therapy currently have no major role in treatment.
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              Malignant melanoma; a clinicopathological analysis of the criteria for diagnosis and prognosis.


                Author and article information

                Case Rep Gastroenterol
                Case Reports in Gastroenterology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, )
                May-Aug 2008
                09 July 2008
                09 July 2008
                : 2
                : 2
                : 224-231
                aDepartment of Surgery, Technical University of Munich, Munich, Germany
                bDepartment of Pathology, Technical University of Munich, Munich, Germany
                cInstitute of Radiology, Technical University of Munich, Munich, Germany
                dDepartment of Surgery, Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany
                Author notes
                *Michael Kranzfelder, MD, Department of Surgery, Technical University of Munich, Ismaningerstrasse 22, DE–81675 Munich (Germany), Tel. +49 89 4140 2085, Fax +49 89 4140 4815, E-Mail kranzfelder@
                Copyright © 2008 by S. Karger AG, Basel

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on and the terms of this license are included in any shared versions.

                Figures: 3, References: 15, Pages: 8
                Published: July 2008

                Gastroenterology & Hepatology

                fdg-pet, esophageal cancer, malignant melanoma


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