A Long Term Survival Case of Esopageal Primary Marignant Melanoma with Melanotic Hyperplasia and Intramural Metastases: A Case Report

Kenichi Sunayama, Masakazu Takagi, Keiko Kobayashi, Toshiyuki Ori, Noriyuki Ohba, Kazuhiko Nakagami, Johji Iseki, Kazusige Tohyama and Hiroyuki Muro^*

Department of Surgery and ^*Department of Pathology, Shizuoka Prefectural General Hospital

We report a case of primary esophageal malignant melanoma. A 64-year-old man, who was diagnosed in his childhood as having complete situs inversus, was admitted to our hospital complaining of dysphagia. An esophagogram revealed an elevated tumor in the middle thoracic esophagus. Flat blackish lesions were also observed endoscopically in the lower thoracic esophagus. A diagnosis of malignant melanoma was made from the biopsy sepecimens. Thoracic esophagectomy with lymph node dissection was performed under a left thoractomy. Histopathologically, primary malignant melanoma with junctional activity was confirmed, including pT1b, pN0, M0 (pStage I) according to Guide Lines for the Clinical and Pathologic Studies on Carcinoma of the Esophagus. Atypical melanotic hyperplasia was seen in a wide area of the resected esophagus. The blackish lesions in the lower thoracic esophagus were diagnosed as intramural metastases. Though the atypical melanotic hyperplasia extended to proximal end of the resected specimen, the patient in alive without recurrence for 24 months after the operation. Thus, we suggested that the atypical melanotic hyperplasia might not be a metacronous change of the malignant melanoma but was rather background factor of the malignant melanoma.

Key words
malignant melanoma of esophagus, melanosis, atypical melanotic hyperplasia

Reprint requests
Sunayama Kenichi Department of Surgery 2, Hamamatsu Univ. School of Medicine, 3600 Handa-cho, Hamamatsu, 431-3192 JAPAN

Accepted
October 22, 1999

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