Laparoskopische Cholecystektomie bei einer isolierten Gallenblasenmetastase eines malignen Melanoms

Abstract

Metastasized malignant melanomas can affect all organs of the human body. However, isolated metastatic spreading into the gallbladder is rare. We treated two asymptomatic patients who had undergone primary curative resection of a melanoma. Gallbladder structures suggesting the presence of tumors were noticed in the follow-up investigations. The two patients underwent laparoscopic cholecystectomy to clarify their pathological relevance. Histologically, the tumor was a metastasis of the malignant melanoma in each case. Surgery is indicated in stage IV in isolated metastatic spreading to the gallbladder in order to avoid symptoms or tumor complications. Since the vast majority of melanoma metastases of the gallbladder are located intraluminally and lymphadenectomy in the region of the hepatoduodenal ligament does not appear to be appropriate, the operation should be carried out laparoscopically. The value of postadjuvant chemoimmunotherapy after metastasis resection is being investigated in numerous studies at present.

Metastatic melanoma of the gallbladder: An unusual clinical presentation of acute cholecystitis

“…Recently, cholecystectomy has been indicated for patients with isolated, resectable gallbladder metastases, and can achieve longer survival [2,4] . As an alternative to open surgery, the laparoscopic approach has arisen as a minimally invasive option [5,8,9] . From the literature, the prognosis of metastatic melanoma to the gallbladder is dismal, with a median survival of 69 mo [2,4,8] and longterm diseasefree survival is achieved in only 1%2% of patients [2] .…”

“…The patient underwent explorative laparotomy and open cholecystectomy. Despite appro priate therapy, the diagnosis of this condition portends a poor prognosis, with very few patients surviving more than 12 mo [4,5] .…”

Primary Malignant Melanoma of the Gallbladder: A Case Report and Review of the Literature

“…Patient series of the researchers named Velez, Seelig, and Kohler exemplify patient series with malignant melanoma of the gallbladder including metastatic cases. In these series, average survival time varies, but is less than 1 year [8, 22, 23]. In the cases with primary malignant melanoma of the gallbladder, another controversial issue is the surgical treatment procedure.…”

“…Another issue is the extent of the surgical dissection. Basically, the cases with malignant melanoma of the gallbladder with diffuse metastases should be considered as grade 4 and for these patients, palliative cholecystectomy rather than aggressive surgery should be performed to sustain patient comfort [21, 23, 24]. But for the patients with isolated malignant melanoma of the gallbladder, we think that surgical treatment option should be conventional cholecystectomy and lymph node dissection, that is, hepatoduodenal lymph node dissection, should be done with surgery as aggressive as possible.…”

Metastatic Melanoma in the Gallbladder: Report of a Case

“…7 According to recent publications, metastatic malignant melanoma presented either as episodes of acute cholecystitis or was asymptomatic and found during followup in patients who had undergone resection of primary melanomas elsewhere in the body. 1,[6][7][8][9][10] Tumors in the gallbladder are diagnosed by imaging examinations, such as US, intravenous cholangiography, retrograde cholangiopancreatography (ERCP), and CT. [11][12][13] US is the examination of choice, with high specificity and sensitivity for evaluating metastatic lesions within the gallbladder. 14 Daunt and King performed the first ultrasonographic imaging of a metastatic melanoma, 11 and Avila et al later announced the importance of color Doppler for obtaining a preoperative indication of malignancy due to pathologic angiogenesis of the lesion shown.…”