<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452025000600016</article-id>
<article-id pub-id-type="doi">10.1159/000544073</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Unveiling a Rare Cause of Dysphagia]]></article-title>
<article-title xml:lang="pt"><![CDATA[Desvendando um caso raro de disfagia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Graça]]></surname>
<given-names><![CDATA[Ana Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Luís]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gravito-Soares]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gravito-Soares]]></surname>
<given-names><![CDATA[Elisa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gama]]></surname>
<given-names><![CDATA[João Martins]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[Pedro Narra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Coimbra Hospital and University Centre Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,University of Coimbra Faculty of Medicine ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Coimbra Hospital and University Centre Anatomic Pathology Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>32</volume>
<numero>6</numero>
<fpage>16</fpage>
<lpage>23</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452025000600016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452025000600016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452025000600016&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Malignant melanoma of the esophagus is an uncommon cause of dysphagia and accounts for only 0.1-0.2% of esophageal neoplasms. Diagnosis is based on esophagogastroduodenoscopy (EGD) with biopsies and immunohistochemical analysis, the latter being crucial in the amelanocytic variant. Gastrointestinal melanomas are more invasive and comprise poorer prognosis than cutaneous melanomas.  Case Presentation:  The authors present the case of a 70-year-old woman admitted to the emergency department for progressive dysphagia with 2 months of evolution. EGD revealed the presence of an extensive, eccentric lesion, occupying approximately half of the luminal circumference at the level of the distal esophagus with circumferential involvement of the esophagogastric junction and cardia. Thoracoabdominopelvic computed tomography and positron emission tomography showed signs of advanced disease. The initial endoscopic biopsies were inconclusive, and EGD was repeated with multiple biopsies directed at the most in&#64257;ltrative areas, whose histopathological analysis with immunohistochemistry revealed neo-plastic cells with marked nuclear positivity for SOX10 and cytoplasmic positivity for vimentin, Melan-A, and HMB45 with absence of melanin pigment, &#64257;ndings suggestive of esophagocardiac amelanocytic malignant melanoma. In a multidisciplinary team meeting, the neoplasm was deemed unresectable, and the proposal was for esophageal stent placement and palliative hormone therapy.  Discussion:  Primary amelanocytic malignant melanoma is an exceptionally rare neoplasm and an extremely uncommon cause of dysphagia. In this context, we present a compelling case study that underscores the rarity of this histological type, the importance of directing biopsies to the most suspicious areas of the lesion to increase diagnostic yield, the need for a high clinical suspicion, and the atypical endoscopic presentation associated with the amelanocytic subtype.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  O melanoma maligno do esófago é uma causa rara de disfagia e corresponde apenas a 0.1-0.2%das neoplasias esofágicas. O diagnóstico baseia-se na endoscopia digestiva alta (EDA) com biópsias e estudo imunohistoquímico dirigido, sendo esta última crucial na variante amelanocítica. Os melanomas gastrointestinais são mais invasivos e têm um prognóstico mais reservado do que os melanomas cutâneos.  Apresentação do caso:  Os autores apresentam o caso de uma mulher de 70 anos admitida no serviço de urgência por disfagia progressiva com 2 meses de evolução. EDA revelou a presença de uma lesão extensa, excêntrica, ocupando cerca de ½ da circunferência luminal a nível do esófago distal com envolvimento circunferencial da transição esófagogástrica e cárdia. Tomogra&#64257;a Computarizada (TC) toracoabdominopélvica e Tomogra&#64257;a por Emissão de Positrões (PET) com sinais de doença avançada. As biópsias endoscópicas iniciais foram inconclusivas, tendo-se repetido EDA com realização de múltiplas biopsias dirigidas às áreas mais in&#64257;ltrativas, cuja análise histopatológica com estudo imunohistoquímico revelou células neoplásicas com marcada positividade nuclear para SOX10 e citoplasmática para vimentina, MELAN A e HMB45 com ausência de pigmento de melanina, achados sugestivos de melanoma maligno amelanocítico esofagocárdico. Em reunião multidisciplinar, a neoplasia foi considerada irressecável, tendo sido proposta para colocação de prótese esofágica e quimioterapia com intuito paliativo.  Discussão:  O melanoma maligno amelanocítico primário é uma neoplasia excecionalmente rara e uma causa extremamente incomum de disfagia. Neste contexto, os autores apresentam um caso clínico que destaca a raridade desse tipo histológico, a importância de direcionar as biópsias para as áreas mais suspeitas da lesão para aumentar o rendimento diagnóstico, a necessidade de um elevado índice de suspeição clínica e a apresentação endoscópica atípica associada ao subtipo amelanocítico.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Dysphagia]]></kwd>
<kwd lng="en"><![CDATA[Esophagus]]></kwd>
<kwd lng="en"><![CDATA[Primary malignant melanoma]]></kwd>
<kwd lng="pt"><![CDATA[Disfagia]]></kwd>
<kwd lng="pt"><![CDATA[Esófago]]></kwd>
<kwd lng="pt"><![CDATA[Melanoma maligno primário]]></kwd>
</kwd-group>
</article-meta>
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