TY - JOUR
T1 - Asymptomatic malignant melanoma of the gallbladder with multiple brain metastases diagnosed with endoscopic ultrasound-guided fine-needle aspiration cytology
AU - Tamura, Koji
AU - Umemura, Yoshiro
AU - Hijioka, Susumu
AU - Date, Kenjiro
AU - Maehara, Naoki
N1 - Publisher Copyright:
© 2019, Japanese Society of Gastroenterology.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Malignant melanoma of the gallbladder (MMG) is extremely rare and its early stage diagnosis is difficult. Most reports of MMG describe metastatic tumors. We herein report a rare case of presumed primary MMG diagnosed by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) cytology without surgical resection. A 72-year-old Japanese male was diagnosed with multiple brain metastases. Fluorodeoxyglucose (FDG) positron emission tomography showed an abnormal uptake of FDG at the gallbladder; enhanced CT and MRI also showed an enhanced gallbladder lesion, which indicated a malignancy. We performed endoscopic naso-gallbladder drainage. However, cytological examination of the drained bile showed no evidence of malignancy. Finally, EUS-FNA was performed to confirm the histological diagnosis; cytopathological assessment, including immunohistochemical analysis, showed a cluster of small to large-sized cells with nuclear pleomorphism and melanin pigment, which was compatible with malignant melanoma. The patient subsequently underwent chemotherapy; however, he died 2 months after diagnosis. In patients with gallbladder tumors, MMG should be suspected even in patients with no history of malignant melanoma or any cutaneous lesions. EUS-FNA is safe and useful to confirm histological diagnoses and to determine optimal treatment strategies.
AB - Malignant melanoma of the gallbladder (MMG) is extremely rare and its early stage diagnosis is difficult. Most reports of MMG describe metastatic tumors. We herein report a rare case of presumed primary MMG diagnosed by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) cytology without surgical resection. A 72-year-old Japanese male was diagnosed with multiple brain metastases. Fluorodeoxyglucose (FDG) positron emission tomography showed an abnormal uptake of FDG at the gallbladder; enhanced CT and MRI also showed an enhanced gallbladder lesion, which indicated a malignancy. We performed endoscopic naso-gallbladder drainage. However, cytological examination of the drained bile showed no evidence of malignancy. Finally, EUS-FNA was performed to confirm the histological diagnosis; cytopathological assessment, including immunohistochemical analysis, showed a cluster of small to large-sized cells with nuclear pleomorphism and melanin pigment, which was compatible with malignant melanoma. The patient subsequently underwent chemotherapy; however, he died 2 months after diagnosis. In patients with gallbladder tumors, MMG should be suspected even in patients with no history of malignant melanoma or any cutaneous lesions. EUS-FNA is safe and useful to confirm histological diagnoses and to determine optimal treatment strategies.
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U2 - 10.1007/s12328-019-00957-z
DO - 10.1007/s12328-019-00957-z
M3 - Article
C2 - 30830674
AN - SCOPUS:85062674056
VL - 12
SP - 490
EP - 494
JO - Clinical Journal of Gastroenterology
JF - Clinical Journal of Gastroenterology
SN - 1865-7257
IS - 5
ER -