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WHO Classification of Tumours
Secondary tumours of the gallbladder and extrahepatic bile ducts


Incidence and origin
Metastases to the gallbladder and extrahepatic biliary tree are uncommon. Although virtually any primary malignancy can metastasize to the gallbladder or biliary tract

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Disibio G, French SW (2008)
Metastatic patterns of cancers: results from a large autopsy study.
Arch Pathol Lab Med 132: 931-9



, melanoma accounts for > 50% of all reported cases of metastasis to the gallbladder and biliary tract
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Carstens HB, Ghazi C, Carnighan RH, Brewer MS (1986)
Primary malignant melanoma of the common bile duct.
Hum Pathol 17: 1282-5



, followed by carcinomas of the stomach and breast
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Disibio G, French SW (2008)
Metastatic patterns of cancers: results from a large autopsy study.
Arch Pathol Lab Med 132: 931-9



. Secondary involvement of the gallbladder or extrahepatic biliary tract may result from transcoelomic spread in the setting of peritoneal carcinomatosis, or by direct extension from carcinomas of adjacent organs. Primary malignant melanoma of the gallbladder or extrahepatic biliary tract is even more rare than metastatic melanoma
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Carstens HB, Ghazi C, Carnighan RH, Brewer MS (1986)
Primary malignant melanoma of the common bile duct.
Hum Pathol 17: 1282-5




Click to access Pubmed
Safioleas M, Agapitos E, Kontzoglou K, Stamatakos M, Safioleas P, Mouzopoulos G, Kostakis A (2006)
Primary melanoma of the gallbladder: does it exist? Report of a case and review of the literature.
World J Gastroenterol 12: 4259-61




Click to access Pubmed
Samplaski MK, Rosato EL, Witkiewicz AK, Mastrangelo MJ, Berger AC (2008)
Malignant melanoma of the gallbladder: a report of two cases and review of the literature.
J Gastrointest Surg 12: 1123-6




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Washburn WK, Noda S, Lewis WD, Jenkins RL (1995)
Primary malignant melanoma of the biliary tract.
Liver Transpl Surg 1: 103-6



. Features that favour a primary melanoma in this location are the presence of junctional activity in the epithelium adjacent to the tumour
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Carstens HB, Ghazi C, Carnighan RH, Brewer MS (1986)
Primary malignant melanoma of the common bile duct.
Hum Pathol 17: 1282-5




Click to access Pubmed
Ricci R, Maggiano N, Martini M, Mulé AM, Pierconti F, Capelli A, Larocca LM (2001)
Primary malignant melanoma of the gallbladder in dysplastic naevus syndrome.
Virchows Arch 438: 159-65



, and the absence of a primary melanoma elsewhere in the body. However, junctional activity has been reported in metastatic melanoma of the gallbladder.

Clinical features
Metastases to the gallbladder or extrahepatic biliary tract are most often asymptomatic. In patients who do have symptoms, the most common presentations are biliary colic

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Ballas KD, Rafailidis SF, Demertzidis C, Alatsakis MB, Pantzaki A, Sakadamis AK (2005)
Mixed exocrine-endocrine tumor of the pancreas.
JOP 6: 449-54



, acute cholecystitis
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De Simone P, Mainente P, Bedin N (2000)
Gallbladder melanoma mimicking acute acalculous cholecystitis.
Surg Endosc 14: 593




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Vernadakis S, Rallis G, Danias N, Serafimidis C, Christodoulou E, Troullinakis M, Legakis N, Peros G (2009)
Metastatic melanoma of the gallbladder: an unusual clinical presentation of acute cholecystitis.
World J Gastroenterol 15: 3434-6



, or biliary obstruction
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Garas G, Bramston B, Edmunds SE (2000)
Malignant melanoma metastatic to the common bile duct.
J Gastroenterol Hepatol 15: 1348-51




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Madsen JA, Tallini G, Glusac EJ, Salem RR, Braverman I, Robert ME (1999)
Biliary tract obstruction secondary to mycosis fungoides: a case report.
J Clin Gastroenterol 28: 56-60



.

Macroscopy
Both intraluminal metastases and diffuse wall infiltration or stricture formation by metastases to the gallbladder have been described

Click to access Pubmed
Madsen JA, Tallini G, Glusac EJ, Salem RR, Braverman I, Robert ME (1999)
Biliary tract obstruction secondary to mycosis fungoides: a case report.
J Clin Gastroenterol 28: 56-60



. Primary melanoma of the gallbladder is most often seen as an intraluminal polypoid mass
Click to access Pubmed
De Simone P, Mainente P, Bedin N (2000)
Gallbladder melanoma mimicking acute acalculous cholecystitis.
Surg Endosc 14: 593




Click to access Pubmed
Safioleas M, Agapitos E, Kontzoglou K, Stamatakos M, Safioleas P, Mouzopoulos G, Kostakis A (2006)
Primary melanoma of the gallbladder: does it exist? Report of a case and review of the literature.
World J Gastroenterol 12: 4259-61




Click to access Pubmed
Samplaski MK, Rosato EL, Witkiewicz AK, Mastrangelo MJ, Berger AC (2008)
Malignant melanoma of the gallbladder: a report of two cases and review of the literature.
J Gastrointest Surg 12: 1123-6



.

Histopathology
The features of metastases to the gallbladder and extrahepatic biliary tree are similar to those observed for metastases to other organs. Primary melanomas of the gallbladder and extrahepatic biliary tree may have evidence of melanoma in situ (junctional activity) adjacent to the infiltrating component

Click to access Pubmed
Carstens HB, Ghazi C, Carnighan RH, Brewer MS (1986)
Primary malignant melanoma of the common bile duct.
Hum Pathol 17: 1282-5




Click to access Pubmed
Ricci R, Maggiano N, Martini M, Mulé AM, Pierconti F, Capelli A, Larocca LM (2001)
Primary malignant melanoma of the gallbladder in dysplastic naevus syndrome.
Virchows Arch 438: 159-65



.







Christine Iacobuzio-Donahue
Click to contact editor
Christine Iacobuzio-Donahue
Department of Pathology
The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
Baltimore
USA