A 67-year-old patient presented with a two-month history of dysphagia without vomiting or associated constitutional symptoms.
Personal history included psoriasis, smoking and alcohol abuse.
The physical examination did not reveal adenopathies in accessible territory, the abdomen was blandom and depressible, painless, without masses or organomegaly.
No cutaneous malignant lesions were observed.
As part of the study, a gastroscopy showed a pedunculated pigmented polypoid formation with a vellous and ulcerated appearance, friable to the contact, which did not occlude the distal esophageal lumen.
Biopsies were taken from it, which were compatible with melanoma of epithelioid cells with immunohistochemical markers S100 positive and HMB45 antigen negative and cytokeratin negative.
To complete the extension study, an abdominal computed tomography was performed, in which an endocardial mass compatible with neoplasia was described at the level of the esophagus, without signs of local recurrence or metastasis at distance.
Positron emission tomography (PET) was requested, in which hypermetabolism was observed in the distal esophagus with no metastatic uptake suggesting primary tumor melanoma, and esophageal exclusion.
The most common surgical treatment was esophagectomy and subtotal gastrectomy - Lewis with regional lymphadenectomy mediastinal and celiac region, gastric plasty in posterior mediastinal situation and anastomosis at the level of the arch.
The postoperative stay was three weeks, the patient evolved favorably without complications and tolerating a normal diet at discharge.
Macroscopic anatomopathological examination of the surgical specimen showed the presence of a pigmented polypoid lesion with radial growth, focally ulcerated, 4.3 x 2.4 x 2 cm, located in the distal third of the esophagus.
The location of the lesion was composed of epithelioid and fusiform cells, some of them with melanotic pigment, with marked nuclear atypia and mitotic activity.
Near the polypoid lesion, foci of radial growth were confirmed.
Tumor located up to the submucosal layer.
Proximal, distal and circumferential margins were tumor free.
Of the 20 lymph nodes dissected, only one had micrometastases of melanoma.
Tumor cells showed immunohistochemical staining for S100, Melan-A and HMB45.
Cytokeratin AE1/AE3 and CEA staining was negative.
With these anatomopathological findings the definitive diagnosis was primary melanoma of the esophagus stage IIA (T2N0M0).
