5
腏腗腕腉 臼腪腬腦腭腧腶膆膒臋臏 Vol. 35, pp. 213217, 2007 腎腌腏腅腃腓腁腀腁腋腐腇腑腄腍腈腊腉腂 1 腒腆腔 腘腤 腉腅 腍腅 1 腅腍 腐腟 腛腗 腄腋 2 腙腉 腊腦 腖腅 腑腍 1 腒腍 腈腉 腛腥 腜腠 1 腑腊 腡腑 1 腙腤 腚腝 腣腏 1 腟腕 腒腉 腛腗 1 腟腇 腅腔 腥腆 3 腞腏 腉腦 腟腎 腛腥 3 腒腉 腟腎 腢腋 3 : 19 8 10 66 15 5 膰膄臞腟腡膢膭腓臮膞腞膄腥膨腶腟腡臩膊腉腣腥臘臱臟臱臒臲腕腢腂腘膕腻自膫膃膄膃膄臖腝腎CT 膱臅 腑腖腆腠臛膑腔臸腕臖腼膊腵膗膃腆腠膛膖臙腲腒膬腕腬腭 腝腎膄膃 CT 膱臅腑腖腻致臙腲膄膉膰膃腍腷臶腕腬膃腇臬腺腼腥腼膊臈腥膟腤腌腎臦膅膖臎膧膱臅腑腖腔腙腚臙臶腕膥臉 膞臶腼膊腝腎腻自膫膃膄膃膄臖臬臻膱膮膇腖腮臶臀臭臖腑腁腏 腰自腟腡腮臶臀臭臖腕腴腒膺腄腎膍膆腖臃腑腁腡膤膍腔腐膫膈 膗臊腥腊腎腇臲臫腇腮膅腊39 腼腮腔腽腉腣腎腼膠腔腐腻膛膖臍致臙腲膸臫膄膑臲腔腝腎腮臶臀臭臖腕膴腷膃腱腕膏腖臃腑腁腏腎腇腼膊腕臆腅腟腗臬臠膲腟腡腇臆腞膺腄腠腣腎腊腀腖腈 腮臶臀臭臖 腕腮臶臀臭臖腖膐膎腑腖190 膿腥腜腢腡腥膜腓臕膕腑腁腢 1ῌῐ4腛腎5 腌膡5 膵腒膵腖腾膥腑腁腢 5臂膌 腴腥腎腊腎膜腓臮腒膺 腄腠腣腢腮臶臀臭臖腕 1 腥膫膳腊腎腕腑腋腢: 66 : 膞腞腅腂腘: 臶膹膄膯臖61 膍臢臶膢臶膹膄膯臖膎臁臁腔腐腻膹膄膯臖臡膤臝64 腃腒腘: 膝腋腘腈臑膼腓腊腐腄腘: 膡腾腓腊腸臗45 20 61 腆腔腘: 13 6 膰腟腡至腩腀腫腔臠腊腐 腂腎15 5 膰膄臞腟腡膢膭腓臮膞腞膄腥腍腕膵37C 腻腱腝腎腎腝15 7 膨腶腟腡臩膊腉腣腹腥臘臱腊腎腓腁腋腆腏: 160 cm, 40 kg, 膯腯 10474 mmHg, 膓腶 92 366C腳臔臺 膶膻腺膁腖膓臲腕腢腂腘膕膑腽膯腓腊膙膣膮腓腊膄膃1 臼腪腬腦腭腧腶膆膆膒膾臱膤腫2 膪膚膚膅3 臼腪腬腦腭腧腶膆腼膠213 47

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Table 1� Laboratory Data on Admission

Figure 1. On chest CT examination, a tumor-like lesion

with irregular-shaped margin was observed in

the mediastinum.

Figure 2. On abdominal CT examination, shadows of

multiple soft tissues were found around both

kidneys and abdominal walls.

O¹º» PQ¼H &214

48

Page 3: 1igakukai.marianna-u.ac.jp/idaishi/www/354/06-35-4Keito...branching area of the bronchus. On abdominal CT examination, shadows of multiple soft tissues were found around the kidneys,

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Figure 3. An exophytic tumor, 14.0�8.0 cm was located in the lower esophagus. Thetumor had uneven surface with foci of pigmentation. �Macroscopic appearance�

Figure 4. The esophageal tumor showed infiltration of

melanoma cells. �Hematoxylin Eosin staining,�200�

Figure 5. Melanoma cells spread along the basal layer

of the esophageal mucosa. �HematoxylinEosin staining, �100�

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1� 89f*� g:;h� <=>?i� j��klm�+!� &�#�$%�P���@An��oB� pN�qer 1988; 29:93�103�

2� CD*� s�tP� EuFv� #�$%� 1�� Gastroenterol Endosc 1994; 36: 2422�2431�

3� wGxH� I>yz� {|}*� u9PJ� ~�K� �>�z� L� )�+!� &�#�$%� 1�� 3�M��dSe�r 2000;61: 2321�2325�

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6� The Japanese Society for Esophageal Diseases.Comprehensive registry of esophageal cancer in

Japan �1995, 1996, 1997� 2001: 39, 87, 135.7� The Japanese Society for Esophageal Diseases.Comprehensive registry of esophageal cancer in

Japan �1998, 1999� 2002: 39, 87.8� \>��� gX��� R� ¡� ¢>Y�� ~&£¤� ¢�¥� ¦§]� ^=tz� ��¨©1� ª8_H� «`P�� ¬\P¥� >8a� &�#�$%� 1�� ­.®b�¯qr2005; 65: 3�7�

9� Allen AC and Spitz SL. Malignant melanoma.A clinicopathological analysis of criteria for

diagnosis and prognosis. Cancer 1953; 6: 1�45.10� {|}*� {°Qc� ~�±P� d²³� e´Wµ� f>?H� w¶Y·¸� ^>gh� �=ij� g:k}� :> }� &�#�$%� 1�� ¹�l 2005; 40: 417�420�

Figure 6. Immunohistochemistry revealed melanoma

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50

Page 5: 1igakukai.marianna-u.ac.jp/idaishi/www/354/06-35-4Keito...branching area of the bronchus. On abdominal CT examination, shadows of multiple soft tissues were found around the kidneys,

Abstract

An Autopsy Case of Esophageal Malignant Melanoma

with Systemic Metastasis

Keito Torikai1, Hideaki Ikejima2, Teisuke Nakagawa1, Hirohumi Takeoka1,

Yasuji Sugano1, Nobuyoshi Narita1, Takahide Matsuda1, Ichiro Maeda3,

Masahiro Hoshikawa3, and Masayuki Takagi3

The patient was a 66-year-old male. He experienced a complete loss of appetite during the last 10 days

of May 2003. A neighborhood practitioner introduced the patient to our hospital. At the time of the first

medical examination, the patient showed marked emaciation and subcutaneous tumors on the right

brachium and in the abdomen. On chest CT examination, a tumor-like lesion with irregular-shaped margin

was observed in the mediastinum. Enlarged lymph nodes were also observed in the hilum of the lung to the

branching area of the bronchus. On abdominal CT examination, shadows of multiple soft tissues were found

around the kidneys, abdominal walls and in the buttock. On endoscopic examination of the upper digestive

tract, a protuberous lesion was observed in the lower esophagus with circumferential stenosis. The biopsy of

the tumors on the right brachium and in the abdomen showed figures of malignant melanoma. All of these

results led us to the diagnosis of esophageal malignant melanoma with systemic metastasis. Surgical

treatment was di$cult and was followed up while giving symptomatic treatment. The patient’s general

condition deteriorated and he died the on the 39th day after hospitalization. Autopsy revealed metastases of

melanoma throughout the body; subcutanea, left lung, right bronchus, both kidneys, thyroid glands,

stomach, pancreas, heart, pericardium, peritoneum, and mesentery. The primary location of the metas-

tastatic melanoma could not be identified, but it was assumed to be the the lower part of the esophagus,

judging from the largest tumor diameter and findings related to the tissue.

1 Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School ofMedicine2 Department of Pharmacotherapeutics, Showa Pharmaceutical University3 Department of Pathology, St. Marianna University School of Medicine

�������� 1�� 217

51