09/10/2015 4:00 PM Suffix - Tissue Types HI027524G/15

1 - Lymph Node 2 - Lymph Node

3 - Stomach

Report sequence 1 Authorised 22/10/2015 12:17

NATURE OF SPECIMEN:

1. Hepatic artery lymph node.

2. Sub carinal lymph node.

3. Stomach and oesophagus.

CLINICAL DETAILS:

None given on request form.

GROSS DESCRIPTION:

1. Fat measuring 65mm x 25mm x up to 15mm. On slicing there is a firm white lymph node measuring up to 10mm. A+B = representative TS, C = additional bit of fat away from nodes. 3B, SK.

2. Fatty tissue measuring up to 40mm x up to 30mm x up to 10mm. A+B = individual nodes, C = lymph node complex, some kept. 3B, SK.

3. An Ivor Lewis oesophogastrectomy with oesophagus 90mm x up to 35mm x up to 30mm and greater curve 30mm, lesser curve 25mm. The paraoesophageal fat extends for 60mm x 55mm x up to 18mm with some pleura extending over 70 x 55mm. Non-peritonealised oesophageal tissues are blue. Pleural surface inked black. On slicing the oesophagus contains a exophytic, polypoid mass measuring up to 40 x 20 x 23mm, centred 40mm above the gastro-oesophageal junction and with a clearance of 25mm from the oesophageal resection margin and at least 50mm from the gastric resection margin. A = proximal margin, B = second slice, C = darker nodule underneath the polypoid mass, D+E = slice between tumour and the gastro-oesophageal junction, G = gastric margin, H-K = tumour, L-U = paraoesophageal fat, V-Z = targeted sampling of the gastric fat. 26B, SK.

HISTOLOGY:

1. The specimen includes two lymph nodes, both showing reactive changes only.

2. The specimen includes six lymph nodes, each showing reactive changes only.

3. The oesophagogastrectomy specimen contains an ulcerated, nodular, epithelioid malignant melanoma which infiltrates to a depth of at least 15 mm, up to, but not beyond, the muscularis propria. There is no definite evidence of vascular invasion. The squamous epithelium adjacent to the melanoma contains a basal proliferation of atypical melanocytes showing some pagetoid upward spread, consistent with the presence of a primary oesophageal origin.

There is no evidence of dysplasia, carcinoma or malignant melanoma (in situ or invasive) at either the proximal or the distal resection margins. The melanoma has a minimum clearance of 1.3 mm from the circumferential resection margin (although it should be noted that the melanoma is confined within the oesophageal wall).

Seventeen lymph nodes have been sampled, one of which contains metastatic malignant melanoma (para-oesophageal 1/11, para-gastric 0/6).

Conclusion: Malignant melanoma within the oesophagus. Para-oesophageal lymph node involvement.

Comment: The presence of the atypical junctional melanocytic proliferation adjacent to the malignant melanoma is most suggestive of a primary oesophageal malignant melanoma. I note that there is no history of a previous malignant melanoma on the pathology database at Derriford Hospital.

09/10/2015 4:00 PM Suffix - Tissue Types HI027524G/15

1 - Lymph Node 2 - Lymph Node

3 - Stomach

Report sequence 2 Authorised 17/11/2015 15:18

By Dr P Malcolm _CELLPATH (Dr Malcolm) PC

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SUPPLEMENTARY REPORT dated 17.11.15

Please refer to earlier report

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The following report was received from Molecular Diagnostics, The Royal Marsden Hospital, Surrey. Lab No: 15/8702

REPORT SUMMARY:

The sample was suitable for molecular analysis, containing 70% neoplastic nuclei after macro-dissection.

No mutations were detected in the regions analysed within the BRAF or NRAS genes. The patient is therefore unlikely to respond to BRAF-inhibitor therapies.

(Dr P Malcolm/DC)

I agree. Pigmented epithelioid MM with junctional suggesting primary,

polypoid and invading submucosa. One involved paraoesophageal

subcapsular LN. Margins clear. T1b N1 (1/17) R0

og mdt outcome: PHNT PT. Underwent endoscopy and found lesion 37-39

cm. Imaging reviewed: CT 2/9 not reported Histology: malignant

melanoma. Radiological stage T2N1. Plan: see in clinic & discuss CT next week.