대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Primary esophageal malignant melanoma

Radiologic Findings

Fig 1. Chest PA shows upper esophageal dilatation, suspicious for an intraluminal obstructing mass.
Fig 2-5. CT shows a large solid intraluminal mass (approximately 65.7 × 38.6 mm) in the mid-thoracic esophagus, likely arising from the left posterior esophageal wall, with avid homogeneous enhancement.
Fig 6. F-18 FDG PET-CT shows a hypermetabolic mass in mid-thoracic esophagus (maxSUV=9.0).

Brief Review

Endoscopic image shows a poorly marginated protruding mass in mid-thoracic esophagus. Malignant melanoma was confirmed by biopsy.

Primary malignant melanoma of the esophagus is a rare but aggressive tumor that composes less than 1% of all malignant esophageal neoplasms. The tumor is twice as common in men as in women, occurs in the 6th and 7th decades of life, and is most commonly located in the middle or distal third of the esophagus.
The most common presenting symptoms are dysphagia (73%), weight loss (72%), pain (44%), and melena (10%). Physical signs other than weight loss are uncommon.
Barium esophagography usually reveals a polypoid mass in the middle or distal third of the esophagus.
CT of the thorax may reveal a bulky esophageal mass, with compression of adjacent mediastinal structures. As with other esophageal malignancies, CT may be most useful in demonstrating mediastinal invasion, nodal enlargement, and distant metastatic disease. Melanoma usually involves the local-regional nodes, lung and/or pleura, and liver.
The treatment of choice for primary melanoma of the esophagus is surgical resection en bloc, with dissection of the lymph nodes. Because of the potential for ‘‘satellite’’ mucosal tumor nodules, the surgical procedure should include a radical resection with a greater margin than that used for the usual squamous cell carcinoma.
The prognosis for patients with this tumor is dismal. Metastases are present at the time of diagnosis in 49% of cases. Despite curative or palliative surgical resection, patients with this aggressive malignancy usually present late in the course of disease and progress to early death, with widespread metastases

References

1. Gollub MJ, Prowda JC. Primary melanoma of the esophagus: radiologic and clinical findings in six patients. Radiology. 1999;213(1):97-100. doi:10.1148/radiology.213.1.r99oc3797
2. Yoo CC, Levine MS, McLarney JK, Lowry MA. Primary malignant melanoma of the esophagus: radiographic findings in seven patients. Radiology. 1998;209(2):455-459. doi:10.1148/radiology.209.2.9807573

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