A Case of Amelanotic Malignant Melanoma of the Esophagus Diagnosed after the Resection of Small Bowel Metastases

Akihiro Kanno¹⁾²⁾, Hiroo Naito¹⁾, Michinaga Takahashi¹⁾, Sinji Goto¹⁾, Tatsuya Ueno¹⁾ and Handou Hakozaki³⁾

Department of Surgery, South Miyagi Medical Center¹⁾
Department of Surgery²⁾ and Department of Pathology³⁾, Fukusima Rousai Hospital

We report a case of amelanotic malignant melanoma of the esophagus, preceded by metastatic lesions of the small bowel. A 74-year-old man came to our hospital complaining of abdominal pain and general fatigue. UGI series revealed two jejunal tumors, and the jejunum was partially resected. The tumors were histologically diagnosed as undifferentiated carcinoma. The patient returned to our hospital 17 months later complaining of difficulty swallowing. A tumor in the mid-portion of the thoracic esophagus was diagnosed as undifferentiated carcinoma by biopsy of the tumor exposed on the mucosal surface. A CT scan demonstrated a large, 8 cm×5 cm, metastatic lymph node in the posterior mediastinum, that had shifted the left atrium anteriorly and the esophagus to the right. We abandoned tumor resection because of the far advanced infiltration and treated the patient with chemotherapy based on a low-dose FP regimen. The chemotherapy resulted in a temporary partial response, but the patient died of tumor recurrence 25 months after the primary operation (7 months after the start of chemotherapy). At autopsy the esophageal tumor was HMB-45-positive, and the final diagnosis was amelanotic malignant melanoma with mediastinal lymph node metastasis and asynchronous metastatic lesions of the jejunum.

Key words
malignant melanoma, esophageal melanoma, amelanotic melanoma

Reprint requests
Akihiro Kanno Department of Surgery, South Miyagi Medical Center
38-1 Aza-nishi, Oogawara, Shibata-gun, 989-1253 JAPAN

Accepted
June 22, 2005

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