PRIMARY MALIGNANT-MELANOMA OF THE ESOPHAGUS - RADIOGRAPHIC FINDINGS IN 7 PATIENTS

PURPOSE: To evaluate the radiographic findings in a series of patients with primary malignant melanoma of the esophagus. MATERIALS AND METHO DS: Seven cases of primary esophageal melanoma were collected from the Hospital of the University of Pennsylvania and the radiologic archive s of the Armed Forces institute of Pathology. All patients underwent e sophagography (double-contrast esophagograms in four patients, single- contrast esophagograms in three patients). Medical, endoscopic and pat hology reports were also reviewed. RESULTS: Six patients presented wit h dysphagia (average duration, 5 months). The remaining patient had re cent onset of melena. In all patients, barium studies revealed -bulky, polypoid intraluminal masses that focally expanded the esophagus with out causing obstruction. The tumors were located in the distal third o f the thoracic esophagus in four patients, the middle third in two, an d the proximal third in one. Tumor pigmentation was noted at endoscopy in only one patient. All patients underwent extensive esophageal rese ction. Of four patients with clinical follow-up findings, two were ali ve and well 2 and 6 months after surgery; the other-two had metastases to the lung and liver within 2 months of surgery. CONCLUSION: Primary esophageal melanomas have strikingly similar barium study findings, a ppearing as bulky, polypoid intraluminal masses that focally expand th e esophagus without causing obstruction. Despite its rarity,primary es ophageal melanoma should be considered when characteristic findings ar e present on barium studies.