Primary Malignant Melanoma of the esophagus in a 39-year-old Filipino male: A case report
- Author:
Arrene Joy B. Baldonado
1
Author Information
1. Department of Radiological Sciences, Section of Nuclear Medicine and PET-CT center, Cardinal Santos Medical Center
- Publication Type:Journal Article
- Keywords:
Primary malignant melanoma of the esophagus;
Fluoro-2-deoxyglucose positron emission;
Tomography and computed tomography (FDG-PET/CT);
Chemotherapy and immunotherapy
- MeSH:
Melanoma;
Positron-Emission Tomography;
Fluorodeoxyglucose F18;
Immunotherapy
- From:
The Philippine Journal of Nuclear Medicine
2022;17(1):16-23
- CountryPhilippines
- Language:English
-
Abstract:
Primary malignant melanoma of the esophagus (PMME) is an exceptionally rare condition, representing a mere
0.1 to 0.2% of esophageal cancers, and accounting for just 0.1 to 0.5% of all melanomas. This case involves a 39
-year-old Filipino male who sought medical attention after an episode of choking. Subsequently, endoscopy with
biopsy revealed a mass in the distal third of the esophagus, ultimately diagnosed as PMME based on
histopathology and immunohistochemistry. FDG-PET/CT scan revealed a hypermetabolic distal esophageal
mass and a confluent upper paratracheal lymphadenopathy. He was initially treated with Pembrolizumab,
Nivolumab, and Ipilimumab immunotherapy. However, post-treatment FDG PET/CT scans unveiled metabolic
progression of the esophageal mass with new hypermetabolic cervical lymph nodes, necessitating a shift to
carboplatin and paclitaxel chemotherapy. After two cycles, there was a notable metabolic regression of the
mass and paratracheal node with metabolic resolution of the cervical lymph node. An additional 2 cycles of
chemotherapy were given, aimed to further reduce the size of the tumor, however, a succeeding follow-up
study revealed metabolic progression of the mass. Surgical resection of both the esophageal mass and
paratracheal nodes became imperative. The aggressive characteristics, metastasis at early diagnosis, and lack
of effective treatment have contributed to the poor prognosis of PMME. Total esophagectomy is the preferred
method of treatment. Chemotherapy and immunotherapy may be used in advanced diseases but with variable
efficacy. The utilization of FDG PET/CT scans plays a crucial role in both the initial staging and the ongoing
assessment of treatment response in patients diagnosed with PMME. This advanced imaging modality offers
valuable insights into the extent of the disease and aids clinicians in evaluating the effectiveness of the chosen
therapeutic interventions. Given the rarity and challenges associated with PMME, a multidisciplinary approach
integrating surgical, medical, and imaging strategies is essential for comprehensive patient care.
- Full text:17 (1) article 2.pdf
