Metastatic Gallbladder Melanoma Presenting as Acute Emphysematous Cholecystitis

Abstract

Malignant melanoma is an aggressive tumor with a high potential for distant metastases, including spread to the gallbladder where it represents more than half of all metastases detected at autopsy. Yet, it is rarely symptomatic in life and is a rare cause of acute cholecystitis. Emphysematous cholecystitis is a rare, potentially fatal variant of acute cholecystitis characterized by the presence of gas in the gallbladder lumen or wall. We report a 77-year-old woman with acute emphysematous cholecystitis as the initial feature of recurrent melanoma metastatic to the gallbladder. This exceptional association highlights the need to consider a relapse of malignancy when assessing unexplained abdominal symptoms in any patient with a prior history of melanoma.

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

“…Local nodal dissection was not performed because the tumor was intraluminal. 50,51 Metastasectomy combined with immunotherapy of melanoma offers a strong advantage to these patients, thus, prolonging their survival. Proceeding with LC offered the advantage of quick recovery, as the patient continued therapy immediately with an immunotherapeutic agent.…”

“…Most cases were treated with classic open surgical excision (45.2%). In cases of diffuse disease, open surgical excision is advantageous in avoiding clinical manifestations of the disease and preventing further dissemination 2,50,51 . In these cases, open cholecystectomy followed by partial V‐segmentectomy is performed.…”

“…Despite the technical challenges, LC was considered the treatment of choice, as the lesion to be resected, was restricted only to the gallbladder and with no other obvious site of metastasis. Local nodal dissection was not performed because the tumor was intraluminal 50,51 …”

“…In cases of diffuse disease, open surgical excision is advantageous in avoiding clinical manifestations of the disease and preventing further dissemination. 2,50,51 In these cases, open cholecystectomy followed by partial Vsegmentectomy is performed. Although an open approach is often preferable, 3 laparoscopic dissection, when executed by an experienced surgeon, is an adequate and highly efficient method.…”

Tomografía computada y resonancia magnética en la patología de la vesícula biliar: más allá de la litiasis

“…El fundus es el sitio más frecuente de perforación por su mala irrigación vascular 21 . -La colecistitis enfisematosa (CE) es una variante causada por bacterias anaeróbicas, más frecuente en pacientes con diabetes o isquemia resultante de aterosclerosis de la arteria cística con una mortalidad del 15-20% 1,22 . En TC se identifica el gas intramural e intraluminal, y suele ser alitiásica (Fig.…”