Isolated gallbladder metastasis of melanoma: Case report

Malignant melanoma located in the ureter and gallbladder: A case report and literature review

RATIONALE

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.

PATIENT CONCERNS

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.

DIAGNOSES

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.

INTERVENTION

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.

OUTCOMES

One month after treatment, the patient imaging showed no disease progression, and at 6 months of follow-up, the patient was still alive.

LESSONS

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.

Nasopharyngeal malignant melanoma masquerading in the gallbladder: the importance of histological assessment

Metastatic melanoma of the gallbladder is a rare entity that is often diagnosed late, leading to a poor prognosis. The disease may present insidiously as acute cholecystitis or remain asymptomatic. Optimal management remains unclear but surgical resection is considered the mainstay of treatment for this condition. We report the case of a 47-year-old man who suffered a protracted course of generalised abdominal symptoms eventually culminating in a diagnosis of acute cholecystitis. Following an emergency laparoscopic cholecystectomy, the histology revealed a melanoma with an unknown primary. Subsequently this was traced to the nasopharynx. Because of the presence of concurrent liver metastasis, systemic immunotherapy with palliative intent was commenced following a multidisciplinary team discussion. This case highlights the importance of sending clinical specimens for histological analysis. We argue against selectively choosing which specimens to send for histology because radiological and/or intraoperative macroscopic inspection of resected tissue alone can result in a missed diagnosis.

Trocar Site Recurrence after Laparoscopic Cholecystectomy for Unsuspected Isolated Gallbladder Metastasis of Melanoma: A Case Report and Review of the Literature

Cutaneous melanoma can metastasize to almost any organ, including in-transit metastases, lymph nodes, liver, lungs, brain, and bones. Spread to the gastrointestinal tract is less common and generally concerns the small bowel, colon, and stomach. Gallbladder involvement is rarer, and only few cases describe it as the sole site of metastasis upon diagnosis. Melanoma metastases to the gallbladder are usually detected on staging or surveillance imaging, as patients usually show few or no symptoms. In resectable stage IV melanoma patients, complete surgical resection appears to improve the prognosis. However, due to the rarity of isolated gallbladder metastasis of melanoma, there are no guidelines regarding the optimal surgical approach (endoscopic or open cholecystectomy). Here, we report the case of isolated gallbladder melanoma metastasis found after laparoscopic cholecystectomy performed in a 46-year-old female patient with no known history of cancer presenting with acute cholecystitis symptoms. Six weeks after surgery, the patient developed trocar site recurrence. This case highlights the importance of a planned and open surgery for resectable melanoma metastases rather than a laparoscopic approach.

Metastatic melanoma to the gallbladder presented as a polyp with acute cholecystitis: A case report from Syria

Introduction and importance

Malignant melanoma is one of the most aggressive unpredictable tumors that can metastasize to any organ. Metastases from cutaneous melanoma to the gallbladder are exceedingly rare. Most patients with gallbladder metastases from malignant melanoma are usually asymptomatic; therefore, its diagnosis can be a real challenge.

Case presentation

We report a case of a 71-year-old woman with a past history of cutaneous melanoma, who clinically presented with signs and symptoms of acute cholecystitis. Ultrasound investigation of the gallbladder revealed intraluminal polyp. Gross inspection of the excised gallbladder showed a polypoid lesion in the fundus. Microscopically, the H&E-stained sections revealed nests of malignant cells, occasionally with pigmented cytoplasm. The diagnosis of metastatic melanoma was reported, and supported by the results of the immunohistochemical stains.

Clinical discussion

Malignant melanoma is a very aggressive type of skin cancer. It arises from the melanocytes in the epidermis, uvea, meninges, and intestinal tract. Worldwide, only 40 cases of metastatic melanoma to the gallbladder were documented. Moreover, reviewing the English-language literature showed that primary melanoma is an extraordinary event and was described in about 28 cases. Clinically, metastases from cutaneous melanoma to the gallbladder are usually asymptomatic.

Conclusion

We report a metastatic malignant melanoma to the gallbladder presented as a polypoid lesion and clinically manifested as acute cholecystitis.

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Melanoma is the most serious type of skin cancer. The gallbladder is an extremely rare location for metastatic melanoma.

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We report a case of a 71-years old woman with metastatic melanoma to the gallbladder presented as acute cholecystitis.

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Melanoma is a very aggressive tumor. Clinically, metastases from melanoma to the gallbladder are usually asymptomatic.

Role of minimally invasive surgery in the treatment of gallbladder metastatic melanoma. A review of the literature and a case report

Background

Primary and secondary gallbladder melanomas are rare, and only 58 cases have been reported in scientific literature to date. This paper aimed to explore the role of minimally invasive surgery in the management of gallbladder metastatic melanomas.

Case

Herein, we present the case of a 68‐year‐old man with metastatic gallbladder melanoma who was treated with laparoscopic cholecystectomy. Our case management was then compared with that of other cases reported in the literature.

Conclusion

Currently, metastatic melanomas can be considered as a potentially curable disease. Palliation of symptoms and fast recovery following minimally invasive procedures could be beneficial for these patients. Particularly, laparoscopic procedures appear to prolong the survival of gallbladder melanoma patients.

Imaging findings of melanoma metastasis in the gallbladder

Cutaneous melanoma is a common and aggressive neoplasm, and metastases to the gastrointestinal tract mainly affect the small intestine, colon, and stomach. Gallbladder metastasis is uncommon. We present a case of melanoma metastasis in the gallbladder in a 40-year-old man with a previous diagnosis of cutaneous melanoma in the dorsal region. The purpose of this article is to reinforce the importance of imaging exams, adding PET scan as another useful method in patients with melanoma in follow-up.

Malignant metastatic melanoma to the gallbladder: Report of a peculiar case

INTRODUCTION

Melanoma is one of the most aggressive and one of the fastest growing types of cancer. The occurrence of a malignant melanoma in the gastrointestinal tract, either primary or metastatic, is a rare event. Metastatis from cutaneous malignant melanoma to the gallbladder are a highly uncommon finding, usually associated with diffuse metastatic disease and observed during autopsy. The event of a solitary metastasis of malignant melanoma to gallbladder is barely reported.

CASE REPORT

We report a case of a 35-year old Caucasian woman with isolated metastasis of gallbladder from cutaneous primary malignant melanoma managed with laparoscopic cholecystectomy.

DISCUSSION

Gallbladder metastasis as a first site of recurrence represents a rare condition for all cancers. Since the occurrence of an isolated gallbladder metastasis of cutaneous melanoma is an uncommon circumstance, no therapeutic guidelines have yet been proposed. Nevertheless cholecystectomy appears to be the standard of care for the treatment of this unusual condition, especially when symptomatic and for palliative purpose. The surgical approach is still debated, with no unanimous consent between mini-invasive surgery and open technique.

CONCLUSION

In our case, we decided to carry out a three-port laparoscopic cholecystectomy, preferring a mini-invasive approach considering the good performance status of our patient and her young age.