Dong X D, DeMatos P, Prieto V G, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cancer. 1999 Jan 1;85(1):32-9.
Both primary and metastatic melanoma of the gallbladder are rare. In cases involving isolated tumors of the gallbladder, there continues to be controversy regarding the establishment of primary status. Despite appropriate therapy, the diagnosis of either condition portends a poor prognosis, with few patients surviving more than 2 years.
A review of all patients seen at Duke University Medical Center since 1970 generated 1 case of primary and 19 cases of secondary melanoma of the gallbladder. These were analyzed with respect to presentation, clinical and pathologic diagnosis, treatment, and prognosis.
The sole patient with a primary lesion presented with acute cholecystitis. Ultrasound demonstrated a mass in the lumen of the gallbladder. Cholecystectomy revealed melanoma, and the patient eventually died of disseminated disease 13.5 months later. Survival was poor for patients who presented with metastases to the gallbladder in the setting of widespread disease, with 0% survival at 1 year (n=11). Those with isolated, resectable lesions fared better overall, with 100% survival (n=6) at 1 year. One patient remains alive and free of disease 13.8 years later, which, to our knowledge, represents the longest documented survival for a patient with melanoma that has metastasized to the gallbladder.
Surgery remains the mainstay of therapy for patients with gallbladder melanoma and appears to improve patient outcome in the setting of resectable disease. Hopefully, further investigations will lead to standardized protocols for the treatment of these lesions.
原发性和转移性胆囊黑色素瘤均较为罕见。在涉及孤立性胆囊肿瘤的病例中，关于原发性状态的判定仍存在争议。尽管采取了适当的治疗方法，但这两种情况的诊断都预示着预后不良，很少有患者能存活超过2年。
对自1970年以来在杜克大学医学中心就诊的所有患者进行回顾，共发现1例原发性胆囊黑色素瘤和19例继发性胆囊黑色素瘤。对这些病例的临床表现、临床和病理诊断、治疗及预后进行了分析。
唯一的原发性病变患者表现为急性胆囊炎。超声显示胆囊腔内有肿块。胆囊切除术显示为黑色素瘤，该患者最终在13.5个月后死于播散性疾病。在广泛疾病背景下出现胆囊转移的患者生存率很低，1年生存率为0%（n = 11）。那些有孤立的、可切除病变的患者总体预后较好，1年生存率为100%（n = 6）。1例患者在13.8年后仍然存活且无疾病，据我们所知，这是有记录的胆囊转移黑色素瘤患者最长的生存时间。
手术仍然是胆囊黑色素瘤患者治疗的主要手段，对于可切除疾病，手术似乎能改善患者的预后。希望进一步的研究能制定出治疗这些病变的标准化方案。
