PMC7338914_01
Computed tomography (CT) scans of the chest, abdomen, and pelvis with contrast reveals a large mass.. [
Superior to inferior, alphabetical] The invasive mass originates in the mid-esophagus (
top, left) at the level of the carina and extends into the upper portions of the stomach (
arrows). At its center along the gastroesophageal junction (GEJ) the mass reaches its greatest dimensions at 6.1 x 9.36 cm. Enlarged gastrohepatic and paraesophageal lymph nodes are concerning for metastatic disease. (
Bottom, right) Left renal lesion with intermediate density (
arrowhead).
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Extending approximately 15 cm, the mass appeared to originate in the mid-esophagus and terminate in the upper gastric tissue ( Figure 1).
Esophagogastroduodenoscopy (EGD) demonstrates an esophageal mass.. The large, necrotic-appearing ulcerated mass is observed to be protruding significantly into the esophageal lumen.
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Near the GEJ, the mass was obstructive, as it occupied approximately 70% of the esophageal lumen ( Figure 2).
Pathology demonstrates a malignant melanoma.. At medium power magnification, histopathology reveals the tumor cells are round with hyperchromatic eccentric nuclei, prominent nucleoli, and mixed eosinophilic and basophilic cytoplasm. Some areas reveal necrosis with neutrophilic exudate. Mitotic activity is frequently seen (HE x100). Pleomorphic melanoma cells containing various amounts of brown melanin pigment (HE x400). At high power magnification, tissue stained with MART-1 (melan-A) by IHC show melanocytes highlighted in brown.
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Tumor cells were positive for MART-1 (melan-A) staining, whereas pankeratin, CD56, synaptophysin, chromogranin, CDX2, p63, and PSA staining was negative ( Figure 3).
Case report timeline. Presented according to CARE guidelines.
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Two months after hospital dismissal the patient expired ( Figure 4).