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Conventional chest X-ray showing a mediastinal mass superimposed on the left heart.
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The workup included a chest X-ray (Fig. 1) revealing a mediastinal mass.
Computed tomography showing transverse (left) and coronal (right) sections through the tumor.
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T8-T11 (Fig. 2). There were no other lesions or masses identified, no lymphadenopathy, and no free fluid.
Barium swallow study showing extrinsic compression of the esophagus. The mediastinal mass is again demonstrated.
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An esophageal contrast study showed extrinsic compression of the posterior esophagus with no mucosal lesion (Fig. 3).
VATS image of clamp displacing mass revealing inflammatory adhesions to the pericardium.
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The tumor was observed to extend directly from the esophagus to the left lower lobe at the fissure but appeared resectable (Fig. 4).
Photomicrograph showing diffuse sheets of atypical cells with dark brown pigments in the background. (Hematoxylin and eosin x 200). Inset shows pleomophic cells with abundant eosinophilic cytoplasm (Hematoxylin and eosin x 400).
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Pathology of the specimen revealed a malignant melanoma, circumscribed, bordering the esophageal adventitia and the pleura of the left lower lobe (Fig. 5).