Hatanaka N, Miyata M, Kamiike W, Okumura K, Hashimoto T, Yamaguchi T, Kishino Y, Sakurai M, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
Surg Today. 1993;23(11):1023-6. doi: 10.1007/BF00308983.
We present herein an usual case of primary malignant melanoma of the gallbladder in a 51-year-old man in whom an exploratory laparotomy for melena revealed six malignant melanoma lesions located in the gallbladder, main pancreatic duct, stomach, duodenum, jejunum, and a mesenteric lymph node. Total pancreatectomy was performed and histologically, junctional activity was seen only in the gallbladder, suggesting that this was the primary site. No melanotic lesions were found on the skin or eyes. The metastases to the main pancreatic duct and gastrointestinal tract appeared likely to have occurred as a consequence of the mucosal dissemination of the tumor cells shed into the bile. The post-operative course was uneventful and combined chemotherapy was administered for 16 months. No new metastatic lesions were found until 21 months postoperatively, when metastases were detected in the brain and thoracic spinal cord. These metastatic tumors were removed surgically, but the patient died from cerebral disturbance 26 months after the initial operation. Thus, we consider that aggressive surgical therapy was effective for extending the survival time and improving the quality of life of this patient.
我们在此报告一例51岁男性原发性胆囊恶性黑色素瘤的罕见病例。该患者因黑便接受剖腹探查术，发现胆囊、主胰管、胃、十二指肠、空肠及一个肠系膜淋巴结存在六个恶性黑色素瘤病灶。实施了全胰切除术，组织学检查显示仅在胆囊发现交界活性，提示此处为原发部位。皮肤和眼睛未发现黑色素沉着病变。主胰管和胃肠道的转移可能是由于肿瘤细胞脱落进入胆汁后黏膜播散所致。术后过程顺利，给予联合化疗16个月。术后21个月前未发现新的转移病灶，之后在脑和胸段脊髓检测到转移。这些转移瘤接受了手术切除，但患者在初次手术后26个月因脑部病变死亡。因此，我们认为积极的手术治疗对于延长该患者的生存时间和改善生活质量是有效的。
