Department of Urology, the 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
Department of Respiratory Medicine, the 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
Medicine (Baltimore). 2024 Feb 23;103(8):e37302. doi: 10.1097/MD.0000000000037302.
Melanoma is one of a common cutaneous malignancy. Currently, metastatic malignant melanoma is difficult to be diagnosed through imaging examinations. Furthermore, the incidence of metastatic melanoma affecting the gallbladder and ureter is exceptionally rare.
A 54-year-old female was admitted to the hospital with a half-month history of left lower back pain. Correlative examination revealed an occupying lesion in the mid-left ureter and the neck of the gallbladder.
The patient was initially diagnosed with gallbladder cancer and left ureteral carcinoma based on imaging. Following 2 operations, immunohistochemical staining confirmed the presence of metastatic melanoma involving both the gallbladder and ureter.
After multidisciplinary consultation and obtaining consent from the patient and her family, the patient underwent left radical nephroureterectomy, radical cholecystectomy, laparoscopic partial hepatectomy (Hep IV, Hep V), and lymph node dissection of hepatoduodenal ligament.
One month after treatment, the patient imaging showed no disease progression, and at 6 months of follow-up, the patient was still alive.
It is difficult to distinguish metastatic melanoma from carcinoma in situ by imaging. In addition, metastatic malignant melanoma lacks specific clinical manifestations and is prone to misdiagnosis, which emphasizes the highly aggressive nature of malignant melanoma.
黑色素瘤是一种常见的皮肤恶性肿瘤。目前,转移性恶性黑色素瘤通过影像学检查难以诊断。此外,转移性黑色素瘤累及胆囊和输尿管的发病率极其罕见。
一名 54 岁女性因左腰背痛半个月入院。相关检查发现左输尿管中段及胆囊颈部占位性病变。
根据影像学表现,患者最初被诊断为胆囊癌和左输尿管癌。经过 2 次手术,免疫组化染色证实存在累及胆囊和输尿管的转移性黑色素瘤。
经多学科会诊,并获得患者及其家属同意后,为患者行左根治性肾输尿管切除术、根治性胆囊切除术、腹腔镜肝Ⅳ段和Ⅴ段部分切除术以及肝十二指肠韧带淋巴结清扫术。
治疗 1 个月后,患者影像学检查未见疾病进展,随访 6 个月时仍存活。
影像学难以鉴别转移性黑色素瘤与原位癌。此外,转移性恶性黑色素瘤缺乏特异性临床表现,易误诊,这强调了恶性黑色素瘤高度侵袭性的本质。