Clinical characteristics of primary malignant melanoma of esophagus in elderly Chinese patients
Objective To analyze and summarize the clinical manifestations,pathological characteristics,treatment,and outcomes of primary malignant melanoma of the esophagus(PMME)in elderly Chinese patients.Methods A case study of an elderly patient with PMME was conducted at the Department of Gastroenterology in the China-Japan Friendship Hospital.Additionally,literature and case data on elderly PMME cases reported in China up to July 2023 were gathered and analyzed to summarize the epidemiological characteristics,endoscopic manifestations,clinical presentations,diagnosis,treatment,and prognosis of the disease.Results A comprehensive review of the literature up to July 2023 documented a total of 114 cases of elderly patients with PMME in China,which also included cases from our hospital.Among these cases,there were 68 male patients(59.6％)and 46 female patients(40.4％),ranging in age from 60 to 81 years,with a median age of 65 years.The predominant clinical manifestations observed were dysphagia and choking while eating,followed by chest pain and retrosternal burning sensation.The majority of the lesions were found in the middle and lower segments of the esophagus,predominantly protruding into the lumen,with only 2 cases(1.8％)displaying esophageal mucosal pigmentation.Immunohistochemical analysis revealed that HMB45 was positive in 74 cases(64.9％)and negative in 3 cases(2.6％),while S-100 was positive in 66 cases(57.9％)and negative in 2 cases(1.8％),although data for some patients were not available.Lymph node or distant metastases were present in 45 cases(39.5％),while 38 patients(33.3％)had tumors confined to the esophagus without metastases.Of the 114 patients,61(53.5％)had a follow-up period ranging from 0.3 to 39 months,with a median follow-up time of 6.75 months.Among the patients who survived during the follow-up period,there were 30 cases(26.3％),with a follow-up time of 1 to 39 months and a median follow-up time of 7.5 months.For the deceased patients,the time from consultation to death ranged from 0.3 to 31 months.Conclusions Elderly individuals with PMME in China typically present with a gradual onset,nonspecific symptoms,frequent metastasis upon diagnosis,aggressive behavior,and unfavorable outcomes.
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