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Primary malignant melanoma of the gallbladder: a case report and review of the literature.

Haskaraca MF, Ozsoy M, Ozsan I, Kurt K - Case Rep Surg (2012)

Bottom Line: Ultrasonography revealed increased thickness of the gallbladder wall and a lesion with surrounding fluid sized 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp.Histopathologic evaluation of the surgical specimen after laparoscopic cholecystectomy revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm and dense melanin pigment within the cytoplasm of the tumor cells.As no other focus was identified as a result of the evaluation, the patient was diagnosed with primary malignant melanoma of the gallbladder.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Merkez Efendi State Hospital, 35630 Manisa, Turkey.

ABSTRACT
Malignant melanoma is characterized by the ability of diffuse metastases. Since the first report of an isolated malignant melanoma case of the gallbladder, it is already controversial whether isolated cases are metastatic or primary tumors. A 49-year-old woman appealed to the emergency unit because of abdominal pain. Ultrasonography revealed increased thickness of the gallbladder wall and a lesion with surrounding fluid sized 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp. Histopathologic evaluation of the surgical specimen after laparoscopic cholecystectomy revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm and dense melanin pigment within the cytoplasm of the tumor cells. As no other focus was identified as a result of the evaluation, the patient was diagnosed with primary malignant melanoma of the gallbladder. In this paper, we aimed to define our treatment modality for a case with isolated malignant melanoma of the gallbladder.

No MeSH data available.


Related in: MedlinePlus

Image of polypoid mass attached to the gallbladder wall not showing acoustic shadow.
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fig1: Image of polypoid mass attached to the gallbladder wall not showing acoustic shadow.

Mentions: A 49-year-old woman appealed to the emergency unit because of abdominal pain, nausea, and vomiting. There was not any peculiarity in her own and family medical history. On physical examination, peritoneal tenderness was found in the right upper abdominal quadrant. Laboratory tests revealed leukocytosis (16 000/mm3), other tests were as follows; serum aspartate aminotransferase, 15 IU/L (<30 IU/L) and alanine aminotransferase, 25 IU/L (<30 IU/L); serum alkaline phosphatase, 140 IU/L (100–320 IU/L); serum g-glutamyl transpeptidase, 20 IU/L (16–73 IU/L); and the serum bilirubin, 08 mg/dL (<1 g/dL). Abdominal ultrasonography revealed increased thickness of the gallbladder wall (8 mm) and a lesion with surrounding fluid sized approximately 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp (Figure 1). The patient was diagnosed with acute cholecystitis depending on the clinical signs and laboratory tests. Her complaints resolved after medical treatment and the patient underwent elective laparoscopic cholecystectomy surgery. After intra-abdominal exploration, Calot's triangle was prepared. Cystic duct and artery were isolated, clipped, and cut. The gallbladder was mobilized through retrograde subserous removal and taken out of the abdomen with an endobag. The patient did not experience any surgical problem after laparoscopic cholecystectomy surgery and was discharged on the postoperative first day. Histopathologic examination of the surgical specimen revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm, vesicular nucleus, and prominent nucleolus, which showed infiltration nesting beneath the epithelium of the gallbladder. A dense melanin pigment accumulation within the cytoplasm of the tumor cells was noted (Figure 2). On the histopathologic examination of the gallbladder block, S100, Vimentin, and HMB-45 were found to be positive. The patient was diagnosed with malignant melanoma depending on these data. Further examinations were done to determine if malignant melanoma of the gallbladder was primary or metastatic (detailed physical examination, anamnesis, endosonographic procedures, ocular and dermatologic examinations, and positron emission tomography). The patient was diagnosed with primary malignant melanoma of the gallbladder, since there was no other focus on the evaluation. Chemoimmunotherapy was planned after surgery. The patient died on the 18th month of follow up because of the hemorrhage due to cranial metastasis.


Primary malignant melanoma of the gallbladder: a case report and review of the literature.

Haskaraca MF, Ozsoy M, Ozsan I, Kurt K - Case Rep Surg (2012)

Image of polypoid mass attached to the gallbladder wall not showing acoustic shadow.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475298&req=5

fig1: Image of polypoid mass attached to the gallbladder wall not showing acoustic shadow.
Mentions: A 49-year-old woman appealed to the emergency unit because of abdominal pain, nausea, and vomiting. There was not any peculiarity in her own and family medical history. On physical examination, peritoneal tenderness was found in the right upper abdominal quadrant. Laboratory tests revealed leukocytosis (16 000/mm3), other tests were as follows; serum aspartate aminotransferase, 15 IU/L (<30 IU/L) and alanine aminotransferase, 25 IU/L (<30 IU/L); serum alkaline phosphatase, 140 IU/L (100–320 IU/L); serum g-glutamyl transpeptidase, 20 IU/L (16–73 IU/L); and the serum bilirubin, 08 mg/dL (<1 g/dL). Abdominal ultrasonography revealed increased thickness of the gallbladder wall (8 mm) and a lesion with surrounding fluid sized approximately 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp (Figure 1). The patient was diagnosed with acute cholecystitis depending on the clinical signs and laboratory tests. Her complaints resolved after medical treatment and the patient underwent elective laparoscopic cholecystectomy surgery. After intra-abdominal exploration, Calot's triangle was prepared. Cystic duct and artery were isolated, clipped, and cut. The gallbladder was mobilized through retrograde subserous removal and taken out of the abdomen with an endobag. The patient did not experience any surgical problem after laparoscopic cholecystectomy surgery and was discharged on the postoperative first day. Histopathologic examination of the surgical specimen revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm, vesicular nucleus, and prominent nucleolus, which showed infiltration nesting beneath the epithelium of the gallbladder. A dense melanin pigment accumulation within the cytoplasm of the tumor cells was noted (Figure 2). On the histopathologic examination of the gallbladder block, S100, Vimentin, and HMB-45 were found to be positive. The patient was diagnosed with malignant melanoma depending on these data. Further examinations were done to determine if malignant melanoma of the gallbladder was primary or metastatic (detailed physical examination, anamnesis, endosonographic procedures, ocular and dermatologic examinations, and positron emission tomography). The patient was diagnosed with primary malignant melanoma of the gallbladder, since there was no other focus on the evaluation. Chemoimmunotherapy was planned after surgery. The patient died on the 18th month of follow up because of the hemorrhage due to cranial metastasis.

Bottom Line: Ultrasonography revealed increased thickness of the gallbladder wall and a lesion with surrounding fluid sized 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp.Histopathologic evaluation of the surgical specimen after laparoscopic cholecystectomy revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm and dense melanin pigment within the cytoplasm of the tumor cells.As no other focus was identified as a result of the evaluation, the patient was diagnosed with primary malignant melanoma of the gallbladder.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Merkez Efendi State Hospital, 35630 Manisa, Turkey.

ABSTRACT
Malignant melanoma is characterized by the ability of diffuse metastases. Since the first report of an isolated malignant melanoma case of the gallbladder, it is already controversial whether isolated cases are metastatic or primary tumors. A 49-year-old woman appealed to the emergency unit because of abdominal pain. Ultrasonography revealed increased thickness of the gallbladder wall and a lesion with surrounding fluid sized 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp. Histopathologic evaluation of the surgical specimen after laparoscopic cholecystectomy revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm and dense melanin pigment within the cytoplasm of the tumor cells. As no other focus was identified as a result of the evaluation, the patient was diagnosed with primary malignant melanoma of the gallbladder. In this paper, we aimed to define our treatment modality for a case with isolated malignant melanoma of the gallbladder.

No MeSH data available.


Related in: MedlinePlus