Diagnosis and surgical treatment of primary malignant melanoma in esophagus

Objective To investigate the pathological features, diagnosis and treatment of primary malignant melanoma in esophagus (PMME).
Methods The clinical data of 3 patients with PMME who were admitted to the Beijing Friendship Hospital from January 2008 to June 2009 were retrospectively analyzed. All the patients received esophageal barium radiography, electronic fiberesophagoscopy, esophageal endoscopic ultrasonography, computed tomography, and underwent surgery. Adjuvant therapy and immunotherapy were applied postoperatively.
Results The results of barium radiography showed irregular filling defect presentation in the distal esophagus. The results of endoscopy showed a purple black tumor with a length of 3-8 cm in the esophagus. The results of endoscopic ultrasonography showed that the tumor was derived from the mucosal layer with low echo density. The results of computed tomography showed thickness of the lower segment of the esophagus. All the 3 patients received left thoracic approach esophagectomy and esophagogastrostomy. Histopathology and immunohistochemistry confirmed malignant melanoma. The expressions of Mart 1, HMB 45 and S 100 antigen were positive. The survival time of 2 patients was longer than 3 years, and 1 patient died of metastasis 6 months after operation. Conclusions PMME is a kind of rare and malignant tumor with dismal prognosis. Surgical management is the first choice, adjuvant chemotherapy and immunotherapy are hopeful to increase the survival time of the patients.