Primary Malignant Melanoma of Oesophagus with Isolated Small Bowel Metastasis: A Unique Case Report and Review of Literature

P C Munipalle, E Ahmed, Y K S Viswanath

South Tees Hospitals NHS Foundation Trust

Introduction
Primary malignant melanoma of the oesophagus (PMME) is a rare condition. We present a distinctive case of PMME with isolated small bowel metastasis successfully treated by surgical resection. The uniqueness of the case prompts us to present it along with review of literature.

Case Report:
A previously healthy 49 year old white male presented with a two months history of progressive dysphagia for solids along with chronic reflux dyspeptic symptoms. He is a chronic smoker and consumed alcohol in moderation. Physical examination was unremarkable.
Oesophagogastroduodenoscopy identified two intraluminal polypoidal lesions and the biopsy specimen showed poorly differentiated malignant cells that contain large areas of pigment. The cells stained strongly positive for S100 stain, consistent with malignant melanoma of the esophagus. CT scan revealed multiple enlarged cervical lymph nodes of uncertain significance and multiple peri-tumoral enlarged lymph nodes with no obvious abdominal metastasis. PET/CT scan demonstrated a primary malignant melanoma of the esophagus (PMME) with no evidence of disease in lymph nodes.
The patient underwent elective two stage esophagectomy during which a mid small bowel serosal polypoidal lesions was found; this was resected and primary small bowel anastomosis was established. This specimen stained positive for S-100, HMB-45 and CD117 with clear resection margins, suggestive of isolated small bowel metastasis from the PMME. There is no relapse in the follow up period of 9 months..

Discussion:
PMME is a very rare neoplasm, representing only 0.1 % of all oesophageal tumors. Patients with PMME require endoscopic and radiological work-up to determine extend and resectability of the disease. We recommend small bowel follow through examination with contrast for added accuracy in the staging of the disease.


Session: Poster Presentation

Program Number: P215

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