Acute Esophageal Necrosis "Black Esophagus" in a Patient With Advanced Renal Cell Carcinoma: An Autopsy Case Report

Acute esophageal necrosis (AEN), also called "black esophagus," is a rare, life-threatening condition characterized by circumferential black discoloration of the esophageal mucosa, usually secondary to ischemia, impaired mucosal defenses, and gastric acid injury. It is often associated with severe debilitating illnesses, diabetes mellitus, malignancy, and hemodynamic shock, among other comorbidities. We report a female patient in her 80s with a history of breast cancer who presented with gross hematuria and was diagnosed with advanced clear cell renal cell carcinoma with inferior vena cava thrombosis. She underwent radical nephrectomy with vascular reconstruction, and the postoperative course was complicated by bleeding and sudden cardiopulmonary collapse on the second postoperative day, leading to death. Autopsy revealed acute tubular necrosis, cardiomegaly, diffuse alveolar damage, and circumferential black discoloration and necrosis of the distal esophagus, consistent with AEN. To our knowledge, this is the first case of AEN in the setting of renal cell carcinoma reported in the English language literature. The condition was not clinically suspected during hospitalization, underscoring its diagnostic challenge and potential under-recognition.