Metastatic melanoma in an esophagus demonstrating Barrett esophagus with high grade dysplasia.
BACKGROUND
Metastatic melanoma involving the esophagus is rare; the occurrence of metastatic melanoma in a background of Barrett esophagus is rarer still. We report a case of an 80 year-old male who presented to our institution for workup of Barrett esophagus with high-grade dysplasia and who proved to have metastatic melanoma occurring in the background of Barrett esophagus, the first report of this kind, to our knowledge, in the English literature.


METHODS
An 80 year-old Caucasian male was diagnosed at an outside institution with Barrett's esophagus with high grade dysplasia and presented to our institution for therapy. The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus. Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S-100, HMB 45 and Melan-A on immunohistochemistry, consistent with melanoma. Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases. Molecular studies demonstrated that the melanoma was positive for the 1799T>A (V600E) mutation in the BRAF gene. The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia.


CONCLUSIONS
This case demonstrates a unique intersection between a premalignant condition (Barrett esophagus with high grade dysplasia) and a separate malignancy (melanoma). This report also shows the utility of molecular testing to support the hypothesis of primary versus metastatic disease in melanoma.
Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA. dtrembat@unch.unc.edu.
Dimitri G
DG
Trembath
Nicholas J
NJ
Shaheen
Stacey
S
O'Neill
Karen
K
Weck
Kevin G
KG
Greene
D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D014408:Biomarkers, Tumor / Q000235:genetics*; D004938:Esophageal Neoplasms / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D004947:Esophagus / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D058965:MART-1 Antigen / Q000235:genetics; D008297:Male; D008545:Melanoma / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D058950:Melanoma-Specific Antigens / Q000235:genetics; D009154:Mutation; D009362:Neoplasm Metastasis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D009418:S100 Proteins / Q000235:genetics; D058951:gp100 Melanoma Antigen
D014408:Biomarkers, Tumor; D058965:MART-1 Antigen; C548667:MLANA protein, human; D058950:Melanoma-Specific Antigens; C548637:PMEL protein, human; D009418:S100 Proteins; D058951:gp100 Melanoma Antigen; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf