PMC9343968_01
Treatment timeline and clinical examination results. (A) Computed tomography (CT) scan showed a mass (arrow) in the lower esophagus and stomach. (B) Upper gastrointestinal barium examination showed stenosis (arrow) of the lower esophagus and irregular filling defect. (C,D) Gastroscopy showed a large gray mass occupying the esophagus and the fundus of the stomach. (E) Preoperative biopsy sample in hematoxylin and eosin stain showed abundant melanin granules. (F) Immunohistochemical staining results for Human Melanoma Black 45 (HMB45). (G) S100 protein. (H) Microphthalmia Transcription Factor (MITF). (I) Vimentin (VM). (J) Cytokeratin (CK). (K) Surgical specimen showed a polypoid tumor with black pigmentation and ulceration. (L) Surgical specimen in hematoxylin and eosin stain revealed large pleomorphic neoplastic cells with enlarged nuclei and melanin pigments. (M) Local lymph nodes were invaded by malignant melanoma cells (hematoxylin and eosin staining). (N) CT scans 3 months after the operation indicated a new nodule in the left inner lobe of the liver and near the hepatic hilus. The pathology result was uncertain. (O) 18 months after the operation, CT scans 18 months after the operation did not display the previous nodule in the liver.
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Computerized tomography (CT) revealed thickening in the lower esophagus and the fundus of the stomach, with lymph node metastasis in the hepatic-gastric space (Figure 1A). Upper gastrointestinal examination by barium also showed stenosis of the lower esophagus and the fundus of the stomach, with mucosa destruction, irregular filling defect and peristalsis disappearance (Figure 1B). Gastroscopy showed a large malignant mass occupying the lower part of the esophagus and fundus of the stomach (Figure 1C,1D). Biopsy specimen immunohistochemical staining was as followed: HMB45 (+), S100 (+), MITF (+), VM (+) and CK (P) (-) (Figure 1E-1J). Intraoperatively, we observed that there was a hard black mass located in the lower esophagus and the cardia of stomach, with a diameter of about 4 cm (Figure 1K). The tumor invaded serous membrane layer, as well as lymph node around the cardia (including 1+ on the group No. 2, 2+ on the group No. 1), without metastasis in upper and lower incision edge and the nevus is benign (Figure 1L,1M). On February 9th, 2018, the CT examination suggested that a new nodule, about 11 mm x 15 mm in diameter, appeared in the left inner lobe of the liver and near the hepatic hilus (Figure 1N). However, on April 19th, 2019, the CT examination did not present the nodule in the liver again (Figure 1O).