Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review

Figure 1 Imaging and microphotograph of primary malignant melanoma of the esophagus. A: Barium swallow examination showed an irregular filling defect on the lower third of the esophagus, causing mucosa destruction; B: Computed tomography showed an eccentric thickening in the lower third of the esophagus wall, with enhancement; C and D: Esophagoscopy revealed a nonpigmented polypoid tumor with hyperemia and erosion in the lower esophagus, and black lesion scattered on the wall of esophagus; E: Hematoxylin-eosin staining identified malignant melanoma cells in the lamina propria of the esophagus (× 100); F: Immunohistochemical staining with HMB45 (human melanoma black 45) antibody revealed positive tumor cells (× 100).

Figure 2 Correlation of tumor size with gender and tumor location. A: Gender; B: Tumor location.

Figure 3 Site of metastasis in the study cohort. ¹Distant lymph nodes including those in the enterocoelia, neck, mediastinum, and axilla.

Figure 4 Survival of patients with primary malignant melanoma of the esophagus. A: Overall survival; B: Disease-free survival.

Figure 5 Kaplan-Meier curves for patients with primary malignant melanoma of the esophagus. A and B: Comparison between the cases with pT1a, pT1b, and pT2, 3, and 4. Patients at pT1a showed a much better overall survival (OS) and disease-free survival (DFS) than those at pT1b or pT2, 3, and 4. No significant difference was observed between groups at pT1b and pT2, 3, and 4 for OS or DFS; C and D: Comparison between the cases with (+) and without (-) lymph node metastasis (LNM). Patients with LNM (+) showed a lower OS than those with LNM (-); for DFS, the difference was only marginal (P = 0.07); E and F: Comparison between the cases with pTNM I, II, and III/IV. Patients at pTNM I showed a much better OS and DFS than those at II and III-IV. No significant difference was noted between groups at pTNM II and III-IV for OS or DFS; G and H: Comparison between the cases with superficial, polypoid, and other gross classifications. Groups with superficial subtype showed a better OS and DFS than those with other subtypes. No significant difference was noted between groups with polypoid and other subtypes for OS or DFS.