A case of black esophagus with histopathologic description and characterization.

Black esophagus, or acute necrotizing esophagitis, is a blackening of the esophagus that is usually distal with a sharp demarcation at the gastroesophageal border. Black esophagus is known to the gastroenterology community; however, to our knowledge it is virtually unknown in the pathology literature with only a single instance described in 1967. It is thought to occur as a poorly elucidated ischemic phenomenon. We report a case of black esophagus in a 45-year-old woman with a history of cocaine and alcohol abuse who was found unresponsive after a vague 2-day illness. On autopsy examination, the esophagus was black with ischemic necrosis of the mucosa, submucosa, and muscularis propria including a diffuse acute inflammatory infiltrate and brown pigmentation limited to the mucosa. Positive periodic acid-Schiff and negative iron stains suggest that the pigment is lipofuscin, likely secondary to ischemia.

A rare case of malignant pediatric ectomesenchymoma arising from the falx cerebri.

Malignant ectomesenchymoma is a rare tumor arising from mature ganglion cells with immature myogenous elements, with only 4 pediatric intracranial cases having been previously reported. The authors report a rare case of intracranial malignant ectomesenchymoma originating from the falx cerebri in a 10-year-old boy. The patient presented with a 2-week history of headache, nausea, and blurry vision, with mild lateral gaze diplopia. A CT scan revealed a solitary 7.2 × 3.8-cm dural-based mass that extended along the falx. No metastatic disease was identified, and the lesion was grossly resected without complication. Pathological investigation identified single and small groups of cells in a myxoid background, with polygonal or spindle-shaped cells containing eccentric nuclei and prominent nucleoli. Immunohistochemical staining of some cells was positive for smooth-muscle actin, CD99, and vimentin, whereas other cells (often process forming) were positive for S100 protein, synaptophysin, and neurofilament protein. Staining was negative for CD138, CD45, α-fetoprotein, CK AE1/3, glial fibrillary acidic protein, CK7, CK20, CD31, CD34, myoD, and desmin. Normal immunopositivity was seen for INI-1. The Ki 67 immunostaining had < 25% reactivity. The patient was treated with a sarcoma-based chemotherapy regimen and radiation to the craniospinal axis, and was found to be without recurrence or metastatic disease at 20 months.