Iwasaki Kenichi, Ota Yoshihiro, Yamada Erika, Takahashi Kosuke, Watanabe Takafumi, Makuuchi Yosuke, Suda Takeshi, Osaka Yoshiaki, Seshimo Akiyoshi, Katsumata Kenji, Tsuchida Akihiko
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Medicine (Baltimore). 2020 May 29;99(22):e18573. doi: 10.1097/MD.0000000000018573.
Primary malignant melanoma of the esophagus (PMME) is a very rare malignancy accounting for only 0.1% to 0.2% of all malignant esophageal lesions. Presently, there are no standard strategies or clear guidelines for PMME treatment.
Herein, we report a patient who had PMME with multiple lymph node metastases (LNMs) who was treated successfully by esophagectomy. In March 2018, a 74-year-old man with symptoms of continuous dysphagia was referred to our hospital.
Upper gastrointestinal endoscopic examination revealed melanin pigmentation in the middle thoracic esophagus and a pigmented polypoid mass in the lower esophagus. Histopathological examination of the endoscopic biopsy specimen revealed malignant melanoma. Contrast-enhanced computed tomography showed a 3 cm tumor lesion with several enlarged lymph nodes without distant metastasis. The preoperative diagnosis based on the TNM classification was cT2N2M0 stage III.
The patient underwent esophagectomy with lymph node dissection.
Histopathological examination showed that the tumor extended to the submucosal layer of the esophageal wall, with multiple LNMs. Although multiple LNMs were detected, computed tomography scan 15 months after surgery showed no recurrence. Additionally, we analyzed the relationship between the overall survival and the clinicopathological factors including LNMs in 48 previously reported cases of PMME that were surgically treated.
To our knowledge, this is the first report on the effect of LNMs on the prognosis of PMME patients. The analysis revealed the prognostic value of the TNM stage. Early tumor detection and esophagectomy with lymph node dissection may play as key factors for achieving a better overall survival of PMME patients.
原发性食管恶性黑色素瘤（PMME）是一种非常罕见的恶性肿瘤，仅占所有食管恶性病变的0.1%至0.2%。目前，对于PMME的治疗尚无标准策略或明确指南。
在此，我们报告一例患有PMME并伴有多发淋巴结转移（LNM）的患者，其通过食管切除术获得成功治疗。2018年3月，一名出现持续吞咽困难症状的74岁男性被转诊至我院。
上消化道内镜检查显示胸段食管中段有黑色素沉着，食管下段有一个色素性息肉样肿物。内镜活检标本的组织病理学检查显示为恶性黑色素瘤。增强计算机断层扫描显示一个3厘米的肿瘤病灶，伴有多个肿大淋巴结，无远处转移。根据TNM分类的术前诊断为cT2N2M0 III期。
患者接受了食管切除术及淋巴结清扫术。
组织病理学检查显示肿瘤侵犯至食管壁黏膜下层，伴有多发LNM。尽管检测到多发LNM，但术后15个月的计算机断层扫描显示无复发。此外，我们分析了48例先前报道的接受手术治疗的PMME病例中总生存期与包括LNM在内的临床病理因素之间的关系。
据我们所知，这是关于LNM对PMME患者预后影响的首份报告。分析揭示了TNM分期的预后价值。早期肿瘤检测及食管切除术加淋巴结清扫术可能是实现PMME患者更好总生存期的关键因素。
