We present the case of a 58-year-old patient with a personal history of obesity, hypertension, fibromyalgia and D3-D4 disc herniation. She was admitted to another hospital due to clinical symptoms of several months' evolution consisting of lumbosciatica refusing the usual analgesic treatment, a feeling of retrosternal knot, progressive dysphagia and weight loss, where she underwent:
- Cervicothoracoabdominal CT scan: a mass effect was observed in the upper third of the oesophagus, and its exact nature could not be defined.
- Upper gastrointestinal endoscopy: a brownish-black mass was observed in the upper third of the oesophagus, submucosal, non-ulcerated, with an intense vascular network.
- Dorsal CT and MRI: multiple vertebral lesions (in D7 and from D9 to D12) compatible with osteoporotic vertebral crushing.
- Bone scan and tumour markers: negative.
Diagnosed with lumbosciatica due to multiple vertebral lesions of osteoporotic origin in the dorsal spine and oesophageal mass, she was referred to our department to complete the study.
On arrival, the patient presented with low back pain that made ambulation impossible, not yielding to opioid treatment and dysphagia with liquids. On examination she was in very poor general condition, haemodynamically stable and afebrile. She had an abdomen with palpable hepatomegaly measuring 3 cm in diameter and severe pain on palpation of the dorsal spine. At this time the following complementary tests were performed:
- Echoendoscopy: lesion located 18 cm from the dental arch, size 40 x 35 x 18 mm, heterogeneous density, infiltrating and rupturing serosa. No peripheral adenopathies were seen.
- Abdominal ultrasound: liver metastases in segment IV and II of 22 and 26 mm in greatest diameter, respectively. The rest of the examination showed no significant alterations.
- Positron emission tomography: uptake in the form of a tumour mass in the upper third of the oesophagus, with mesenteric implants, multiple liver metastases and bone metastases in the axial and peripheral skeleton.
- Pathological anatomy: malignant melanoma -HMB45: (+), MELAN A: (+), CKPAN: (+)- with areas of necrosis.