Wang Jun-Ke, Su Fei, Ma Wen-Jie, Hu Hai-Jie, Yang Qin, Liu Fei, Li Quan-Sheng, Li Fu-Yu
aDepartment of Biliary Surgery bDepartment of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2017 Nov;96(46):e8793. doi: 10.1097/MD.0000000000008793.
Primary malignant melanoma of the gallbladder is an extremely rare tumor, with fewer than 40 cases reported in the literature worldwide. The majority of patients presented as a solitary lesion in the gallbladder. To our knowledge, only one case of primary malignant melanoma of the gallbladder with multiple metastases has been reported, which involved the stomach, duodenum, pancreas, jejunum and a mesenteric lymph node.
We report a case of primary malignant melanoma of the gallbladder with metastases to the duodenal bulb, right adrenal and a celiac lymph node.
Primary malignant melanoma of the gallbladder with multiple metastases.
Gastrojejunostomy, cholecystectomy, and biopsy of the three metastatic lesions were performed. Histopathologic examination revealed melanin pigments were within the tumor cells of the four lesions, however, junctional activity was noted only in the gallbladder, supporting that the gallbladder was the primary site. No pigmented lesions were detected on the skin or eyes. The postoperative recovery was uneventful, and subsequently, chemotherapy with paclitaxel and carboplatin was administered.
The patient survived for 16 months due to tumor. progression.
The current case was unique due to the adrenal involvement. For patients with multiple metastases of malignant melanoma, gallbladder origin should be considered in the differential diagnosis from cutaneous origin.
原发性胆囊恶性黑色素瘤是一种极为罕见的肿瘤，全球文献报道的病例少于40例。大多数患者表现为胆囊内的孤立性病变。据我们所知，仅报道过1例原发性胆囊恶性黑色素瘤伴多发转移，转移至胃、十二指肠、胰腺、空肠和一个肠系膜淋巴结。
我们报告1例原发性胆囊恶性黑色素瘤，转移至十二指肠球部、右肾上腺和一个腹腔淋巴结。
原发性胆囊恶性黑色素瘤伴多发转移。
实施了胃空肠吻合术、胆囊切除术，并对三个转移病灶进行活检。组织病理学检查显示，四个病灶的肿瘤细胞内均有黑色素，但仅在胆囊中发现交界活性，支持胆囊为原发部位。皮肤和眼部未检测到色素沉着病变。术后恢复顺利，随后给予紫杉醇和卡铂化疗。
患者因肿瘤进展存活了16个月。
本例因肾上腺受累而独特。对于恶性黑色素瘤多发转移的患者，在鉴别诊断时应考虑胆囊来源与皮肤来源。
