A Case of Primary Malignant Melanoma of the Esophagus Successfully Diagnosed by Positron Emission Tomography/CT

Yoshito Okada, Tetsuya Abe, Toshiyuki Arai, Satomi Saeki, Takashi Hiromatsu, Keiji Aizu, Akihumi Nakagawa, Eiji Higaki, Kohei Yamauchi and Syunpei Yokoi

Department of Surgery, Anjo Kosei Hospital

A 75-year-old man with a pigmented elevated polypoid lesion in the middle thoracic esophagus recognized at an annual health check up was diagnosed with malignant esophageal melanoma based on histological examination of endoscopic biopsy specimens. Though PET/CT showed some small lymph nodes in the mediastinum, no accumulation of tracer was found in these lymph nodes except for the primary lesion, and the tumor was diagnosed as primary malignant esophageal melanoma without lymph node involvement. Because PET/CT showed no lymph node metastasis, a radical operation was thought useful and the man underwent subtotal esophagectomy and proximal gastrectomy via right thoracotomy and laparotomy with three-field lymph node dissection. Microscopic findings of the resected specimen confirmed the diagnosis of malignant melanoma. The depth of invasion was the submucosal layer. As diagnosed by preoperative PET/CT, dissected lymph nodes were negative for metastasis dissemination. No adjuvant chemotherapy was done. In 12-month postoperative follow-up, no evidence of recurrence or metastasis has been found. Primary malignant esophageal melanoma is rare and deadly, with no established treatment, but the prognosis of early-stage patients has been reported improved, making preoperative staging evaluation is very important in the treatment strategy for this disease.

Key words
malignant melanoma, esophagus, PET/CT

Reprint requests
Yoshito Okada Department of Surgery, Anjo Kosei Hospital
28 Higashi-Hirokute Anjocho, Anjo, 446-8602 JAPAN

Accepted
February 20, 2008

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