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GE J Port Gastrenterol. 2012;19(3):158---159 www.elsevier.pt/ge ENDOSCOPIC SPOT Esophageal melanocytosis Melanocitose esofágica Cláudia Cardoso a,∗ , Ricardo Freire a , Élia Gamito a , Carlos Quintana b , Isabelle Cremers a , Ana Paula Oliveira a a Servic ¸o de Gastrenterologia, Centro Hospitalar de Setúbal, Setúbal, Portugal b Servic ¸o de Anatomia Patológica, Centro Hospitalar de Setúbal, Setúbal, Portugal Received 6 March 2011; accepted 23 June 2011 Available online 30 May 2012 A 77-year-old woman was presented to our hospital with a six-month history of heartburn and chest pain. The upper gastrointestinal endoscopy revealed several dark flat irregularly delineated areas in the middle third of the esophagus (Fig. 1a and b). Histological examination of these lesions revealed an increased number of pigment-laden dendritic cells in the basal layer of the epithelium, with no cellular atypia that stained positive with Masson-Fontana (Fig. 2), prompting the diagnosis of esophageal melanocytosis. This rare condition is characterized by melanocytic prolifera- tion in the basal layer of esophageal squamous epithelium with an increased deposition of melanin. About 30 cases have been reported so far, the majority of which in Indian Figure 1 (a and b) Dark flat irregularly delineated areas in the middle third of the esophagus. ∗ Corresponding author. E-mail address: [email protected] (C. Cardoso). and Japanese populations. 1,2 The etiology and pathogenesis remain uncertain, although it has been hypothesized that it may result from a chronic irritant stimulus, such as gastroesophageal reflux disease that causes mucosal dam- age and reactive keratinocytic and melanocytic hyperplasia. Overall, these lesions are more common in males and are located in the middle or lower third of esophagus. The pos- sible association with primary esophageal melanoma awaits further investigation to determine whether there is a common pathogenesis or a coincidence of two rare entities in the same patient. Due to its rarity, no current rec- ommendations regarding management and surveillance are available. 3 0872-8178/$ – see front matter © 2011 Sociedade Portuguesa de Gastrenterologia Published by Elsevier España, S.L. All rights reserved. http://dx.doi.org/10.1016/j.jpg.2012.04.030

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GE J Port Gastrenterol. 2012;19(3):158---159

www.elsevier.pt/ge

ENDOSCOPIC SPOT

Esophageal melanocytosis

Melanocitose esofágica

Cláudia Cardosoa,∗, Ricardo Freirea, Élia Gamitoa, Carlos Quintanab, Isabelle Cremersa,Ana Paula Oliveiraa

a Serviço de Gastrenterologia, Centro Hospitalar de Setúbal, Setúbal, Portugalb Serviço de Anatomia Patológica, Centro Hospitalar de Setúbal, Setúbal, Portugal

Received 6 March 2011; accepted 23 June 2011Available online 30 May 2012

A 77-year-old woman was presented to our hospital with asix-month history of heartburn and chest pain. The uppergastrointestinal endoscopy revealed several dark flat irreg-ularly delineated areas in the middle third of the esophagus(Fig. 1a and b). Histological examination of these lesionsrevealed an increased number of pigment-laden dendriticcells in the basal layer of the epithelium, with no cellularatypia that stained positive with Masson-Fontana (Fig. 2),prompting the diagnosis of esophageal melanocytosis. Thisrare condition is characterized by melanocytic prolifera-tion in the basal layer of esophageal squamous epitheliumwith an increased deposition of melanin. About 30 caseshave been reported so far, the majority of which in Indian

Figure 1 (a and b) Dark flat irregularly delineated areas in the middle third of the esophagus.

∗ Corresponding author.E-mail address: [email protected] (C. Cardoso).

and Japanese populations.1,2 The etiology and pathogen-esis remain uncertain, although it has been hypothesizedthat it may result from a chronic irritant stimulus, such asgastroesophageal reflux disease that causes mucosal dam-age and reactive keratinocytic and melanocytic hyperplasia.Overall, these lesions are more common in males and arelocated in the middle or lower third of esophagus. The pos-sible association with primary esophageal melanoma awaitsfurther investigation to determine whether there is a com-mon pathogenesis or a coincidence of two rare entitiesin the same patient. Due to its rarity, no current rec-ommendations regarding management and surveillance areavailable.3

0872-8178/$ – see front matter © 2011 Sociedade Portuguesa de Gastrenterologia Published by Elsevier España, S.L. All rights reserved.http://dx.doi.org/10.1016/j.jpg.2012.04.030
Esophageal melanocytosis 159

Figure 2 Pigment-laden dendritic cells in the basal layer ofthe epithelium that stained positive with Masson-Fontana.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

1. Yamazaki K, Ohmori T, Kumagai Y. Ultrastructure of oesophagealmelanocytosis. Virchows Arch A Pathol Anat Histopathol.1991;418:515---22.

2. Sharma SS, Venkateswaran S, Chacko A. Melanosis of the esoph-agus. An endoscopic, histochemical and ultrastructural study.Gastroenterology. 1991;100:13---6.

3. Chang F, Deere H. Esophageal melanocytosis --- morphologicfeatures and review of the literature. Arch Pathol Lab Med.2006;130:552---7.