BACKGROUND & AIMS:
CONTEXT:Primary esophageal melanoma (PEM) is a rare disease and is difficult to distinguish from other esophageal malignancies and from metastatic melanoma.
OBJECTIVE:To develop diagnostic criteria for PEM, we compared the clinicopathologic features of 5 PEMs and 5 metastatic melanomas to esophagus.
DESIGN:Ten cases of esophageal melanoma, including 4 surgically resected specimens, 2 autopsy cases, and 4 cases reported on mucosal biopsies, were reviewed. The histologic parameters used in this study were well-characterized features for cutaneous melanoma, including junctional component (in situ melanoma), radial growth phase, modified Breslow thickness, depth of invasion, lymphovascular invasion, satellitosis, predominant type of cytology, and regional lymph node metastasis. Clinical and follow-up information was obtained by reviewing patients' medical records.
RESULTS:Previous history of cutaneous melanoma was present in all 5 cases of metastatic esophageal melanoma but was not present in the 5 patients with PEMs. In situ melanoma and/or radial growth phase were identified in all 5 PEMs but were not present in any of the metastatic cases. Among the 4 resected and 2 autopsy cases, melanocytosis and mixed epithelioid and spindle cell morphology was present in 2 (50%) of 4 PEMs but was not present in 2 (40%) of the metastatic melanomas. Melanin pigment was detectable in all cases. Patients with PEM had better survival than those who had metastatic melanoma to esophagus (P = .03).
CONCLUSIONS:The presence of in situ melanoma, radial growth phase, melanocytosis, and mixed epithelioid and spindle cell morphology, in the context of no history of melanoma, distinguishes PEM from metastatic melanoma.
背景与目标:
背景:原发性食管黑色素瘤(PEM)是一种罕见的疾病,很难与其他食道恶性肿瘤和转移性黑色素瘤区分开。
目的:为制定PEM的诊断标准,我们比较了5种PEM和5种转移性黑色素瘤与食道的临床病理特征。
设计:对10例食管黑色素瘤病例进行了回顾性分析,其中包括4例手术切除的标本,2例尸检病例和4例经黏膜活检报告的病例。在这项研究中使用的组织学参数是皮肤黑色素瘤的特征,包括连接成分(原位黑色素瘤),放射状生长期,改良的Breslow厚度,浸润深度,淋巴血管浸润,黄变,主要的细胞学类型和局部淋巴结肿大淋巴结转移。通过回顾患者的病历获得临床和随访信息。
结果:所有5例转移性食管黑色素瘤均存在皮肤黑色素瘤的既往史,但在5例PEM患者中均未见。在所有5个PEM中均发现了原位黑素瘤和/或radial骨生长阶段,但在任何转移病例中均不存在。在4例切除和2例尸检病例中,黑素细胞增多症以及混合的上皮样和梭形细胞形态存在于4个PEM中的2个(50%)中,但不存在于2个(40%)的转移性黑色素瘤中。在所有情况下均可检测到黑色素。与患有转移性黑色素瘤至食管的患者相比,PEM患者的生存期更好(P = .03)。
结论:在无黑素瘤病史的情况下,原位黑素瘤,放射状生长期,黑素细胞增多以及混合的上皮样和梭形细胞形态的存在将PEM与转移性黑素瘤区分开。