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Page 1: 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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Page 2: 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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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.

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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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Page 4: 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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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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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�

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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

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