Primary Malignant Melanoma of the esophagus in a 39-year-old Filipino male: A case report

@#Primary malignant melanoma of the esophagus (PMME) is an exceptionally rare condition, representing a mere 0.1 to 0.2% of esophageal cancers, and accounting for just 0.1 to 0.5% of all melanomas. This case involves a 39 -year-old Filipino male who sought medical attention after an episode of choking. Subsequently, endoscopy with biopsy revealed a mass in the distal third of the esophagus, ultimately diagnosed as PMME based on histopathology and immunohistochemistry. FDG-PET/CT scan revealed a hypermetabolic distal esophageal mass and a confluent upper paratracheal lymphadenopathy. He was initially treated with Pembrolizumab, Nivolumab, and Ipilimumab immunotherapy. However, post-treatment FDG PET/CT scans unveiled metabolic progression of the esophageal mass with new hypermetabolic cervical lymph nodes, necessitating a shift to carboplatin and paclitaxel chemotherapy. After two cycles, there was a notable metabolic regression of the mass and paratracheal node with metabolic resolution of the cervical lymph node. An additional 2 cycles of chemotherapy were given, aimed to further reduce the size of the tumor, however, a succeeding follow-up study revealed metabolic progression of the mass. Surgical resection of both the esophageal mass and paratracheal nodes became imperative. The aggressive characteristics, metastasis at early diagnosis, and lack of effective treatment have contributed to the poor prognosis of PMME. Total esophagectomy is the preferred method of treatment. Chemotherapy and immunotherapy may be used in advanced diseases but with variable efficacy. The utilization of FDG PET/CT scans plays a crucial role in both the initial staging and the ongoing assessment of treatment response in patients diagnosed with PMME. This advanced imaging modality offers valuable insights into the extent of the disease and aids clinicians in evaluating the effectiveness of the chosen therapeutic interventions. Given the rarity and challenges associated with PMME, a multidisciplinary approach integrating surgical, medical, and imaging strategies is essential for comprehensive patient care.

The diagnostic values of MRI, enhanced CT and PET-CT in detecting skull base invasion of nasopharyngeal carcinomas: A comparative study / 肿瘤

Objective: To compare the diagnostic values of magnetic resonance imaging (MRI), enhanced computed tomography (CT), and positron emission tomography (PET)-CT using 18F-fluoro-2-deoxyglucose (FDG) in detecting skull base invasion of nasopharyngeal carcinoma (NPC) and provide the evidence for differentiated diagnosis of the skull base invasion of NPC. Methods: The fifty seven patients were scanned by MRI, enhanced CT, and PET-CT. The three imaging examinations were finished within 20 days. The diagnosis standards were based on histopathologic findings or clinical and imaging follow-up results within 6 months. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the three scanning technologies were compared. Results: For detecting skull base invasion of NPC, the sensitivity of enhanced CT, MRI, and PET-CT were 68.18%, 84.09%, and 97.67%, respectively; the specificity were 76.92%, 69.23%, and 57.14%, respectively; the accuracy were 70.18%, 80.70%, and 87.72%, respectively; PPV were 90.90%, 90.24%, and 87.50%, respectively; NPV were 41.67%, 56.25%, and 88.89%, respectively. PET-CT was better than enhanced CT in sensitivity, accuracy, and NPV (P <0.05). It was also better than MRI in sensitivity and NPV (P <0.05). Conclusion: Among three imaging technologies,PET-CT has obvious advantage in detecting skull base invasion of NPC patients, especially for new patients.