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���� ����������Vol. 35, pp. 213�217, 2007
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���� ����������������� �������������������������� ��� 1������������: ������� !�"��#$LDH ��#�%&'�� (� CEA, SCC ����)*+*�,-./�%&'���� �Table 1��0�1�� 0�� 922��� ����3��� 4��5 X6����� �7��� ground glass opac-ity ��� � �89'�� 4� CT �����:��&;<��=�>���� ��� �?�:���@A$BC�:��D!E����"��&FG�H�IJ$K��LMNO�# ��� �Figure 1�� �� CT ����� $%��&�PQRS�TIJ� ��� '����&'� ���� �(U 89V� �Figure 2�� ��WXGYZ����� 7�:��[\]I��@A ���� �^� ]_`)��*�� ��!a3b� ��WXGcS���de�f��������: +gh� ����$����ibj� de�� kl,�-.��,mn/�op���&'� qrstu*vq, �HMB-45� $q S-100 q,�0wx1yz{�2��3b� |�}{��345�./�3��� (�� ~���ib]_��� ��� |�}{��]_6�$���� 0!78�E������� �9�����:�;��FG��<��ib��`)�|X�+g9 39�=��>�'������: �h 20���?��de�'�� ����� ���� �:�7��3b� :�� 3�4I ��x� 14.0�8.0 cm ��� @��� 1 ���� ���rs�M�j�� ��� �Figure3�� ���$ib� :��%�|�}{�$���6� $��&'x��� A7��4� 7�� ¡4� 10�� �� 20�� ��� 7�� ¡�� 6����� 2��� ��� �FG�����ix@A ;��� ¡TIJ�BG ¢£�� �TIJ� ¤`¥�¦��C� §��� D¨� 0¨��E�� 0F� �F�G�F$$�?�(U�� :�PQ./�� �l� �� kl,�Hx©� ª«)¬M�HI�� Jm�m,®� K¯m�°�,mn/�rst±²³��/ `op�´µ�%&'� �Figure 4����n/�:�LF�¶M��·�E¸Nwx� ��� �Figure 5�� (�� HMB-45z{2��3�� �Figure 6��
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
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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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49
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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� )�+!� &�#�$%� 1�� 3�M��dSe�r 2000;61: 2321�2325�
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5� �XQh� �:�h� �=YZ=� ����-C[��� �� �dL� 2000;82: 724�731�
6� The Japanese Society for Esophageal Diseases.Comprehensive registry of esophageal cancer in
Japan �1995, 1996, 1997� 2001: 39, 87, 135.7� The Japanese Society for Esophageal Diseases.Comprehensive registry of esophageal cancer in
Japan �1998, 1999� 2002: 39, 87.8� \>��� gX��� R� ¡� ¢>Y�� ~&£¤� ¢�¥� ¦§]� ^=tz� ��¨©1� ª8_H� «`P�� ¬\P¥� >8a� &�#�$%� 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}� :> }� &�#�$%� 1�� ¹�l 2005; 40: 417�420�
Figure 6. Immunohistochemistry revealed melanoma
cells reacting to anti-melanosome �HMB-45�antibody. �HMB-45 staining, �200�
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50
Abstract
An Autopsy Case of Esophageal Malignant Melanoma
with Systemic Metastasis
Keito Torikai1, Hideaki Ikejima2, Teisuke Nakagawa1, Hirohumi Takeoka1,
Yasuji Sugano1, Nobuyoshi Narita1, Takahide Matsuda1, Ichiro Maeda3,
Masahiro Hoshikawa3, and Masayuki Takagi3
The patient was a 66-year-old male. He experienced a complete loss of appetite during the last 10 days
of May 2003. A neighborhood practitioner introduced the patient to our hospital. At the time of the first
medical examination, the patient showed marked emaciation and subcutaneous tumors on the right
brachium and in the abdomen. On chest CT examination, a tumor-like lesion with irregular-shaped margin
was observed in the mediastinum. Enlarged lymph nodes were also observed in the hilum of the lung to the
branching area of the bronchus. On abdominal CT examination, shadows of multiple soft tissues were found
around the kidneys, abdominal walls and in the buttock. On endoscopic examination of the upper digestive
tract, a protuberous lesion was observed in the lower esophagus with circumferential stenosis. The biopsy of
the tumors on the right brachium and in the abdomen showed figures of malignant melanoma. All of these
results led us to the diagnosis of esophageal malignant melanoma with systemic metastasis. Surgical
treatment was di$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
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