The Thousand Faces of Malignant Melanoma: A Systematic Review of the Primary Malignant Melanoma of the Esophagus

Clinicopathologic Observations on Primary Malignant Melanoma of the Digestive Tract

ObjectiveWe aimed to investigate the clinical features, histopathological characteristics, immunohistochemical profile, diagnostic and differential diagnostic approaches, and treatment strategies for primary malignant melanoma of the digestive tract.MethodsA retrospective analysis was conducted on 21 patients diagnosed with primary malignant melanoma of the digestive tract between January 2011 and July 2024. The clinical, morphological, and immunohistochemical features of these tumors were systematically evaluated.ResultsThe study cohort included 21 patients (age range: 42-90 years; mean age: 64.8 years) diagnosed with primary malignant melanoma of the digestive tract. All patients underwent surgical treatment, with the majority of tumors located in the anorectal region (15/21), followed by the small intestine (4/21) and esophagus (2/21). Histopathological examination revealed nodular proliferation patterns under low magnification. The tumors were predominantly composed of sheets of epithelioid or spindle-shaped cells that exhibited marked pleomorphism. Melanin pigmentation was identified in 11 tumors. High-power microscopic evaluation demonstrated significant cellular polymorphism, with round, vesicular nuclei containing prominent eosinophilic nucleoli. Frequent mitotic figures were observed throughout the specimens. Notably, two tumors exhibited signet-ring cell-like morphology, characterized by cytoplasmic clearing and peripheral nuclear displacement. Analysis of tumor invasion depth revealed that seven tumors infiltrated the submucosa, six tumors infiltrated the muscularis propria, and eight tumors infiltrated the entire wall. Lymph node metastasis was detected in six patients.ConclusionPrimary malignant melanoma of the digestive tract represents a rare malignancy requiring high clinical suspicion. Endoscopic identification of pigmented lesions should prompt consideration of this diagnosis. Definitive diagnosis requires histopathological confirmation through H&E staining supplemented by immunohistochemical markers (eg, S-100, HMB45, melan-A), combined with imaging tests to exclude metastatic lesions from cutaneous or ocular primary sites.

The first case of primary malignant melanoma of the esophagus to achieve pathologic complete response after preoperative ipilimumab + nivolumab followed by resection

Primary malignant melanoma of the esophagus is a rare disease with a poor prognosis. Surgical resection is common, but there is no consensus on perioperative treatment. Studies have reported the efficacy of programmed cell death-1 inhibitors (e.g., nivolumab, pembrolizumab) and anti-cytotoxic T-lymphocyte-associated antigen 4 agents (e.g., ipilimumab) in treating malignant melanoma. Here, we present the first case of primary malignant melanoma of the esophagus with lymph node metastases treated with nivolumab and ipilimumab followed by resection, achieving a pathologic complete response. A 75-year-old man presented with dysphagia. Esophagogastroduodenoscopy revealed a black, elevated lesion in the mid-thoracic esophagus. Biopsy confirmed primary malignant melanoma of the esophagus, showing tumor cells with melanin deposition, positive for HBM45 and S-100 staining. Computed tomography showed enlarged lymph nodes in the subclavian and mediastinum regions, suggesting metastases. After two courses of preoperative chemotherapy with ipilimumab and nivolumab, which significantly shrank the tumor, the patient underwent robot-assisted subtotal esophagectomy and 3-field lymph node dissection. Histopathological examination revealed no tumors or lymph node metastases, confirming a pathologic complete response. Given the rarity and poor prognosis of primary malignant melanoma of the esophagus, this case provides valuable insights for treatment strategies.

Characteristics analyses and tumor staging proposal for primary malignant melanoma of the esophagus: a retrospective study

Primary malignant melanoma of the esophagus (PMME) is a malignant tumor with a poor prognosis. This study aimed to conduct survival analysis for patients with PMME and propose a staging system for PMME. Data from 179 patients were compiled for survival analysis and to propose a staging system for PMME. Survival analysis was conducted using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. The median OS of the 179 patients with PMME was 20.0 months. The 1-, 3-, and 5-year survival rates were 67.0%, 35.0%, and 17.0%. In the pooled analysis of 179 patients, significant differences in OS were observed between patients with tumors invading the lamina propria or muscularis mucosae (T1a) and deeper layers (T1b, T2, T3, T4) (P < 0.001). Significant differences in OS were observed between patients with no regional lymph node metastasis and those with one or more regional lymph node metastases (P < 0.001). PD-1 inhibitors significantly improved 3-year OS for patients with the pT1b-4 N+ stage (P = 0.020). The proposed staging system for PMME is as follows: (1) Stage I: T1aN0M0 (2) Stage II: T1b-4N0M0 and T1N1M0; Stage III: T2-4N1M0 and TxNxM1(P < 0.001). The lower T-stage and no lymph node metastasis indicated better prognosis. Surgery could be considered an effective treatment for patients with early-stage PMME. The effectiveness of surgery as a treatment for advanced-stage patients remained unclear and required further research. However, PD-1 inhibitors might improve the 3-year OS for advanced-stage patients. Furthermore, the tumor, node, metastasis staging system for PMME was proposed, and could be valuable in guiding prognostic predictions.

A case of primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus (PMME) is an extremely rare esophageal malignancy that is often misdiagnosed or overlooked due to its atypical symptoms. We report a case of a 75-year-old male patient who presented with progressive dysphagia. Endoscopic examination revealed a black mass located 25 cm from the incisors. Further imaging studies, including computed tomography (CT) and emission computed tomography (ECT), showed significant thickening of the mid-esophageal wall with localized soft tissue mass formation and heterogeneous enhancement on contrast scans. Multiple lymph nodes around the lesion were visible, leading to an initial misdiagnosis of esophageal cancer. Additionally, metabolic abnormalities in the left scapula suggested possible bone metastasis of the tumor. The final pathological diagnosis was esophageal melanoma. After thorough evaluation of the patient's medical history and additional relevant tests, the primary origin was considered. Diagnosing primary malignant melanoma of the esophagus is a challenging task. This case, through the combination of endoscopic examination, imaging, and pathology, illustrates the characteristics of PMME, providing important insights for clinicians and emphasizing the necessity of comprehensive early evaluation to improve diagnostic accuracy and treatment outcomes.

Superficial Primary Malignant Melanoma of the Esophagus Detected and Treated at Stage 0

The patient was a 79-year-old male. At three years and eight months after his initial presentation, upper gastrointestinal endoscopy revealed a black-flattened elevated lesion in the middle third of the esophagus, which was diagnosed as malignant melanoma on biopsy. No lymph node or distant metastasis was found. A diagnosis of cT1bN0M0 Stage I was thus made. We performed a robot-assisted, minimally invasive esophagectomy and D2 dissection. The postoperative diagnosis was pT1a-MM, N0, M0, vascular invasion+, stage 0. The patient was recurrence-free for 14 months after surgery. We presume that an aggressive biopsy diagnosis is important for the early detection of malignant melanoma.

A Rare and Rapidly Progressive Case of Primary Esophageal Malignant Melanoma in an Elderly Patient

Primary malignant melanoma of the esophagus (PMME) is a rare malignancy typically associated with poor prognosis, particularly in elderly patients. Here, we present the case of an 85-year-old female patient with a three-month history of progressive dysphagia and heartburn-related epigastric pain. Endoscopy revealed a polypoid esophageal lesion, confirmed as melanoma via biopsy with positive immunohistochemical staining for Melan-A and SOX-10. Given her age, frailty, and comorbidities, she was deemed unfit for surgery. A palliative approach, focusing on symptom management and systemic therapy, was adopted. Unfortunately, her condition rapidly worsened, leading to severe malnutrition and emaciation. The treatment focus shifted exclusively to symptomatic relief and best supportive care, and she ultimately passed away six months after diagnosis. PMME is rare and its diagnosis is challenging, especially in elderly patients; this case emphasizes the importance of individualized treatment plans. Early detection remains difficult due to the asymptomatic nature of early-stage disease. Treatment strategies are limited and should be carefully individualized, particularly in older patients, where the risks of aggressive intervention may outweigh potential benefits. In this group of patients, the emphasis should be placed on quality of life rather than curative intent.

Rare malignant neoplasm of the esophagus: current status and future perspectives

Esophageal cancer is common worldwide, including in Japan, and its major histological subtype is squamous cell carcinoma. However, there are some rare esophageal cancers, including neuroendocrine neoplasm, gastrointestinal stromal tumor, carcinosarcoma and malignant melanoma. The biological and clinical features of these cancers differ from those of esophageal squamous cell carcinoma. Therefore, different treatment strategies are needed for these cancers but are based on limited evidence. Neuroendocrine neoplasm is mainly divided into neuroendocrine tumor and neuroendocrine carcinoma by differentiation and the Ki-67 proliferation index or mitotic index. Epidemiologically, the majority of esophageal neuroendocrine neoplasms are neuroendocrine carcinoma. The treatment of neuroendocrine carcinoma is similar to that of small cell lung cancer, which has similar morphological and biological features. Gastrointestinal stromal tumor is known to be associated with alterations in the c-KIT and platelet-derived growth factor receptor genes and, if resectable, is treated in accordance with the modified Fletcher classification. Carcinosarcoma is generally resistant to both chemotherapy and radiotherapy and requires multimodal treatments such as surgery plus chemotherapy to achieve cure. Primary malignant melanoma is resistant to cytotoxic chemotherapy, but immune checkpoint inhibitors have recently demonstrated efficacy for malignant melanoma of the esophagus. This review focuses on the current status and future perspectives for rare cancer of the esophagus.

Pulsatilla Saponins Inhibit Experimental Lung Metastasis of Melanoma via Targeting STAT6-Mediated M2 Macrophages Polarization

Pulsatilla saponins (PS) extracts from Pulsatilla chinensis (Bge.) Regel, are a commonly used traditional Chinese medicine. In the previous study, we found Pulsatilla saponins displayed anti-tumor activity without side effects such as bone marrow suppression. However, the mechanism of the anti-tumor effect was not illustrated well. Since M2-like tumor-associated macrophages (TAMs) that required activation of the signal transducer and activator of transcription 6 (STAT6) for polarization are the important immune cells in the tumor microenvironment and play a key role in tumor progress and metastasis, this study aimed to confirm whether Pulsatilla saponins could inhibit the development and metastasis of tumors by inhibiting the polarization of M2 macrophages. We investigated the relevance of M2 macrophage polarization and the anti-tumor effects of Pulsatilla saponins in vitro and in vivo. In vitro, Pulsatilla saponins could decrease the mRNA level of M2 marker genes Arg1, Fizz1, Ym1, and CD206, and the down-regulation effect of phosphorylated STAT6 induced by IL-4; moreover, the conditioned medium (CM) from bone marrow-derived macrophages (BMDM) treated with Pulsatilla saponins could inhibit the proliferation and migration of B16-F0 cells. In vivo, Pulsatilla saponins could reduce the number of lung metastasis loci, down-regulate the expression of M2 marker genes, and suppress the expression of phosphorylated STAT6 in tumor tissues. Furthermore, we used AS1517499 (AS), a STAT6 inhibitor, to verify the role of PS on M2 macrophage polarization both in vitro and in vivo. We found that Pulsatilla saponins failed to further inhibit STAT6 activation; the mRNA level of Arg1, Fizz1, Ym1, and CD206; and the proliferation and migration of B16-F0 cells after AS1517499 intervention in vitro. Similar results were obtained in vivo. These results illustrated that Pulsatilla saponins could effectively suppress tumor progress by inhibiting the polarization of M2 macrophages via the STAT6 signaling pathway; this revealed a novel mechanism for its anti-tumor activity.

Primary malignant melanoma of the esophagus: A case report

BACKGROUND

Primary malignant melanoma of the esophagus (PMME) is a rare malignant disease whose clinical and molecular pathological features, origin and pathogenesis, diagnosis and treatment have not been elucidated.

CASE SUMMARY

In this paper, we report a case of a 73-year-old male with PMME. The patient complained of progressive dysphagia accompanied by substantial weight loss. Gastroscopy revealed a purple black bulging-type mass in the lower esophagus with easy bleeding on contact and scattered satellite lesions in the stomach. Histopathological biopsy revealed melanocytes in the esophageal mucosa. Physical examination and multidisciplinary consultation led to diagnostic exclusion of melanoma originating in other organs, such as the skin. Through this case report and literature review, we aimed to describe the clinical and molecular pathological features of PMME and summarize possible pathways of pathogenesis as well as cutting-edge therapeutic advances.

CONCLUSION

PMME is a rare malignancy of the esophagus with a poor prognosis. Clinicians should raise their awareness and be able to identify early lesions.

An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature

Minimally invasive treatment of uterine fibroids usually requires a power morcellation, which could be associated with several complications. A rare sequela is disseminated peritoneal leiomyomatosis. Indeed, recurrence or metastasis in these cases could be attributed to iatrogenic or under-evaluation of primary tumors, although a subset of cases is a sporadic sample of biological progression. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously. The diagnosis was predicted preoperatively by an expert sonographer who recognized the ultrasound characteristics of uterine sarcoma and the localization of some of the masses, so the patient was referred to the gynaecological oncologists who could appropriately treat her. We present here a case report and a systematic review that could be a useful tool for further discussion and future clinical practice guidelines.

Primary esophageal melanoma: a case report

Primary esophageal melanoma remains a rare entity with less than 350 case reports noted in the current literature. This diagnosis is associated with a poor prognosis and early detection and management remains fundamental. In this report, we examine the case of an 80-year-old female who presented with a 1-year course of progressive dysphagia and weight loss. Investigations revealed a primary esophageal melanoma with no evidence of metastases. Pathology did not identify any targetable markers for systematic therapy and thus the patient successfully underwent a minimally invasive esophagectomy. Her postoperative course involved endoscopic esophageal dilatations due to an anastomotic stricture, as well as primary lung adenocarcinoma treated with radiotherapy but has otherwise remained without evidence of melanoma recurrence after 25 months from her surgery.