Malignant melanoma of the oesophagus: Clinicopathological features, lack of p53 expression and steroid receptors and a review of the literature

Abstract

Aims: Fortunately, primary malignant melanoma of the oesophagus is a rare entity. The aims of this study were to evaluate the clinicopathological features, p53 over-expression and steroid receptors in oesophageal melanomas and to review the reported cases in the literature. Methods: Melanomas reported during a 15-year period (1982-1996) in the Queen Mary Hospital were studied. The clinicopathological features and survival data of patients with oesophageal melanomas were noted. Representative tissue was collected from each tumour and immunohistochemical preparations for HMB-45, p53, oestrogen and progesterone receptors were made. A review of oesophageal melanomas reported in the literature was also performed. Results: Three cases of primary malignant melanoma of the oesophagus were found. They accounted for 3% of melanomas and 0.2% of oesophageal cancers diagnosed. The melanomas were fusiform and large at the time of resection. All three patients died of their malignancy within 9 months of operation. The tumours stained positive for HMB-45 and were negative for p53, oestrogen and progesterone receptors. From previous reports, 154 oesophageal melanomas were documented. The tumours were fusiform, large, often pigmented and located in either the middle or lower oesophagus. Although many oesophageal melanomas presented at early stages (stages I or II), their biological behaviour was aggressive. The 5-year survival rate was 5.7%. Conclusions: Melanoma of the oesophagus is an aggressive tumour. There is no evidence for the p53 gene and female sex hormones having a role in the development or progression of the tumour.