We report the case of a 58-year-old woman with a history of obesity, hypertension, fibromyalgia and dyscal hernia D3-D4.
The patient was studied in another hospital by a clinic of several months of evolution consisting of lumbosciatic pain refractory to usual analgesic treatment, sensation of retrosinusitis, progressive dysphagia and weight loss, where it is performed:
- cervico-thoracoabdominal TAC: observing a mass effect in the upper third of the esophagus which cannot precisely define its nature.
- Upper gastrointestinal endoscopy showed a black-brown mass in the upper third of the esophagus, submucosa, not ulcerated, with intense vascular network.
- TAC and dorsal MRI: multiple vertebral lesions (in D7 and from D9 to D12) compatible with osteoporotic vertebral compressions.
- Bone scan and tumour markers: negative.
Diagnosed as lumbosciatic by multiple vertebral lesions of osteoporotic origin in the dorsal spine and esophageal mass, she was referred to our service to complete the study.
On arrival, the patient has low back pain that prevents walking, not giving up opioid treatment and dysphagia to liquids.
The physical examination revealed a very poor general condition, hemodynamically stable and afflicted.
An abdominal CAT scan showed hepatomegaly of 3 cm in diameter and pain very important to palpation of the dorsal spine.
At this time we performed the following complementary tests:
- Echoendoscopy: a lesion located 18 cm from the dental arch, 40 x 35 x 18 mm in size, heterogeneous density, malformations and serous rupture.
No peripheral adenopathies were observed.
- Abdominal ultrasound: highlights liver metastases in segments IV and II of 22 and 26 mm in diameter, respectively.
Rest of the examination showed no significant changes.
- Positron emission tomography: tumor mass uptake in the upper third of the esophagus with mesenteric implants, multiple liver and bone metastases in axial and peripheral skeleton.
- pathological anatomy: malignant melanoma -HMB45: (+), MELAN A: (+), CKPAN: (+)- with areas of necrosis.
