Clin Exp Med DOI 10.1007/s10238-015-0378-x

LETTER TO THE EDITOR

Primary malignant melanoma of the gallbladder: an outstandingly rare tumor Edoardo Virgilio1 • Alessandro Scorsi2 • Pietro Maria Amodio2 • Angelo Goglia2 Raffaele Macarone Palmieri2



Received: 2 July 2015 / Accepted: 8 July 2015 Ó Springer-Verlag Italia 2015

We commend Giannini et al. [1] on their interesting article about two rare cases of gallbladder metastasis from malignant cutaneous melanoma. As for us, we would like to pique interest in another particular and very rare disease involving both melanoma and cholecyst, which is primary malignant melanoma of the gallbladder. A 59-year-old man was submitted to laparoscopic cholecystectomy. Four months before, he underwent a neurosurgical removal of a solitary brain metastasis from unknown primary melanoma. With this histological diagnosis, a whole body 18F-FDG PET scan was arranged revealing a significant uptake only in the gallbladder (GB). Concomitant CT scan showed a mildly hyperdense nodule in the lumen of the GB (Fig. 1). Macroscopic evaluation found a brownish polyp of 2 cm in diameter. The microscopy revealed a malignant melanoma with junctional activity staining positive for protein melan A (Fig. 2). Considering this feature and the absence of other lesions on PET scan, the conclusive diagnosis was primary malignant melanoma of GB. Adjuvant chemoimmunotherapy was given; at 15-month follow-up, no metastasis has been detected. Primary malignant melanoma of the GB (PMMG) is an extremely rare cancer with an ominous prognosis. The first case was described by Weiting and Hamdi in 1907. Since then, as of 2015, only 36 instances have been published in

& Edoardo Virgilio [email protected] 1

Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology ‘‘Sapienza’’, St. Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy

2

Department of General Surgery, Belcolle Hospital, Sammartinese Street, 01012 Viterbo, Italy

Fig. 1 Contrast-enhanced CT scan of the abdomen showing a mildly hyperdense nodule in the lumen of the gallbladder (GB) without any gallstone

the world literature [2]. Histogenesis is still under debate: Melanocytes could follow an ectopic migration from the neural crest or originate from precursor cells resident in GB [3]. Assessing the clinicopathologic features of PMMG is not a simple task for the low number of patients: Both sexes are equally affected and the peak incidence is between 40 and 60 years [2]. A preoperative diagnosis of PMMG is substantially impossible to achieve: postoperatively, the exclusion of other primary sites and the finding of a solitary polypoid melanoma arising from the mucosa of GB showing junctional activity represent its incontestable prerequisites [2–4]. Prognosis is ominous, although PMMG demonstrated the longest median survival (41 months) among the other primary gastrointestinal

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Chemoimmunotherapy is usually administered as palliative care [2–4]. Conflict of interest

None.

References

Fig. 2 Microscopically, the malignant melanoma did not infiltrate the muscular layer of the GB showing a junctional activity and an immunohistochemical profile positive for protein melan A

melanomas [5]. To date, cholecystectomy is the only potentially curative treatment for non-metastatic PMMG; the role of local lymphadenectomy is under discussion.

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1. Giannini I, Cutrignelli DA, Resta L, Gentile A, Vincenti L. Metastatic melanoma of the gallbladder: report of two cases and a review of the literature. Clin Exp Med. 2015. [Epub ahead of print]. PMID: 25929736. 2. Gligorijevic J, Zivkovic V, Djordjevic B, Dimov I. Primary gallbladder melanoma in dysplastic nevus syndrome: report of case and literature review. Turk J Gastroenterol. 2011;22:626–30. 3. Safioleas M, Agapitos E, Kontzoglou K, et al. Primary melanoma of the gallbladder: does it exist? Report of a case and review of the literature. World J Gastroenterol. 2006;12:4259–61. 4. Haskaraca MF, Ozsoy M, Ozsan I, Kurt K. Primary malignant melanoma of the gallbladder: a case report and review of the literature. Case Rep Surg. 2012;2012:693547. 5. Cheung MC, Perez EA, Molina MA, et al. Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg. 2008;12:731–8.

Primary malignant melanoma of the gallbladder: an outstandingly rare tumor.

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