De Simone P, Mainente P, Bedin N
Unità Operativa di Chirurgia Generale, Ospedale Civile, 71 Via Forlanini, 31029 Vittorio Veneto, (TV), Italy.
Surg Endosc. 2000 Jun;14(6):593. doi: 10.1007/s004640000125. Epub 2000 May 8.
Gallbladder (GB) melanoma is a rare entity with a dismal prognosis. Its primary or secondary status is difficult to establish in the absence of an overt cutaneous localization. We report herein the case of a misdiagnosed GB melanoma mimicking acute acalculous cholecystitis that was treated by means of laparoscopic cholecystectomy (LC). A 54-year-old man was referred to our institution for acute cholecystitis. Apart from the ablation of some nevocytic nevi 7 years before admission, the patient's medical history was unremarkable. The ultrasound (US) examination showed a slightly enlarged acalculous gallbladder with thickened walls and a well-circumscribed polypoid mass in the fundus. The patient was treated medically and referred to LC. At surgery, some satellite nodules were visualized in the GB hepatic bed. The GB was removed, and two hepatic nodules were excised. Histology showed a pT3 melanoma. The patient underwent an open hepatic wedge resection 3 weeks after laparoscopy. No recurrence was observed at 6-month follow-up. To date, only one case of melanoma of the gallbladder treated with LC has been reported. GB melanoma is a diagnostic challenge when there is no evidence of a primary lesion. However, the occurrence of acalculous cholecystitis and a GB polyp in patients with a positive history of mole ablation should alert surgeons to the possibility of a melanoma.
胆囊黑色素瘤是一种罕见的疾病，预后很差。在没有明显皮肤定位的情况下，很难确定其原发性或继发性状态。我们在此报告一例被误诊为急性非结石性胆囊炎的胆囊黑色素瘤病例，该病例通过腹腔镜胆囊切除术（LC）进行了治疗。一名54岁男性因急性胆囊炎被转诊至我院。除了入院前7年切除过一些痣细胞痣外，患者既往病史无异常。超声（US）检查显示胆囊轻度增大，无结石，胆囊壁增厚，底部有一个边界清晰的息肉样肿块。患者接受了药物治疗，并被转诊接受LC手术。手术中，在胆囊肝床可见一些卫星结节。切除了胆囊，并切除了两个肝结节。组织学检查显示为pT3黑色素瘤。患者在腹腔镜检查3周后接受了开放性肝楔形切除术。6个月随访时未观察到复发。迄今为止，仅报道过一例接受LC治疗的胆囊黑色素瘤病例。当没有原发性病变的证据时，胆囊黑色素瘤是一个诊断难题。然而，有痣切除史阳性的患者出现非结石性胆囊炎和胆囊息肉应提醒外科医生注意黑色素瘤的可能性。
