Endoscopic Findings in a Patient with Primary Malignant Melanoma of the Esophagus: A Case Report

Primary malignant melanoma of the esophagus (PMME) is a rare tumor with poor prognosis, rapid progression, and early metastasis. It often occurs in the middle to lower part of the esophagus. Endoscopic findings reveal various colors ranging from white, brown, and purple to black, and the lesions could be ulcerative, superficial, or protruding polypoid. Only a few reports about endoscopic findings of PMME are available in the literature. Here, we describe a case of a 77-year-old man who suffered from epigastric pain and acid regurgitation for 2 weeks. Endoscopic findings revealed an ulcerative lesion with purple-black pigmentation in the lower part of the esophagus. Endoscopic biopsy was performed. Hematoxylin and eosin (H&E) staining showed a subepithelial nodule with melanocytosis and a high nuclear-cytoplasmic (N/C) ratio and macronucleoli. Immunohistochemical staining revealed positive results for S-100, HMB-45, and melan-A. Based on these pathologic and immunohistochemical examinations, the patient was diagnosed with PMME. However, the patient initially hesitated to undergo surgical intervention until he developed dysphagia 2 years later. We also present a series of endoscopic images of PMME of this patient in this paper.