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The Dark Side of Dysphagia

Esophageal Melanocytosis

Mir, Adil S. MD1; Kesar, Varun MD2; Grider, Douglas J. MD3; Sorrentino, Dario MD4,5

doi: 10.14309/crj.0000000000000234
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1Department of Internal Medicine, Virginia Tech Carilion, Roanoke Memorial Hospital, Roanoke, VA

2Division of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA

3Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA

4IBD Center Division of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA

5Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy

Correspondence: Adil S. Mir, MD, Department of Internal Medicine, Virginia Tech Carilion, Roanoke Memorial Hospital, Roanoke, VA (Dr.adilshamim@gmail.com).

Received July 23, 2019

Accepted August 28, 2019

Online date: October 15, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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CASE REPORT

A 52-year-old woman with a history of vitamin B12 deficiency and anemia presented for the evaluation of dysphagia, weight loss, and worsening anemia. Esophagogastroduodenoscopy showed an esophageal stricture beyond which the midportion of the esophagus appeared dark brown to black (Figure 1). Pathology of esophageal biopsies revealed dendritic melanocytes in the lower portion of the squamous mucosa, best illustrated on a Fontana-Masson stained tissue section for melanin (Figure 2).

Figure 1

Figure 1

Figure 2

Figure 2

In addition, a Sox10 immunohistochemical stain marked the nuclei of the benign melanocytes, confirming the diagnosis of esophageal melanocytosis (EM) (Figure 3). The patient underwent serial esophageal dilations and proton pump inhibitor therapy with clinical improvement. EM is a rare condition, generally benign, but it has been considered a precursor of primary esophageal melanoma. It has been thought to arise from the abnormal migration of melanocytes or the keratinocytic differentiation of multipotent stem cells in the esophagus. Gastroesophageal reflux disease, smoking, and chronic alcohol use are considered as risk factors. Because of the generally benign nature of EM, radical procedures are generally not considered. However, because of the potential association with esophageal melanoma, a close clinical follow-up is highly recommended.

Figure 3

Figure 3

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DISCLOSURES

Author contributions: All authors contributed equally to this manuscript. AS Mir is the article guarantor.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.