RESUMEN
BACKGROUND: Although metastatic melanoma is most frequently found in liver, lungs, and brain, most metastases found in the gallbladder are from melanoma. Here, we present a case of isolated metastatic melanoma found during cholecystectomy. PRESENTATION OF CASE: 74-year-old male with a personal history of hypertension, diabetes mellitus, obesity, and arrhythmia. A skin lesion was found on the right malar region. An excisional biopsy was performed and histopathological examination showed an ulcerated nodular-type malignant melanoma, Breslow 7.6 mm, Clark IV. Surgical excision with margins of 2 cm and sentinel lymph-node biopsy was carried and were negative. Abdominal sonography at 6 months showed an 18 mm solid mass adhered to the wall of the gallbladder that was suggestive of a polyp. Thorax-abdomen-pelvis CT showed no abnormalities. The gallbladder lesion had increased in volume on the following sonography and therefore, cholecystectomy was performed. Histopathological study revealed melanoma infiltrating the mucosa and muscular layer. Written informed consent was previously obtained, and Institutional Review Board approval was not needed. DISCUSSION: Isolated metastatic melanoma in the gallbladder is uncommon. Follow-up controls with images are important in the diagnosis. As most metastatic melanoma to the gallbladder are asymptomatic, surgeons should have high level of suspicion. Cholecystectomy could prolong survival in these patients. CONCLUSION: Isolated gallbladder metastasis of melanoma is an uncommon presentation of this disease. Laparoscopic cholecystectomy is an adequate procedure in this particular situation and may improve patient survival. The presentation of this case may help surgeons to maintain a high level of suspicion regarding the condition.
RESUMEN
El tratamiento de la Enfermedad Metastásica Cerebral única es paliativo y multimodal desconociéndose con certeza la modalidad o combinación terapéutica óptima. Se planteó como objetivo determinar las diferencias entre la Radioterapia Holocraneal, Radiocirugía, y Resección Quirúrgica en cuanto a la Sobrevida Global, Sobrevida Con Independencia Funcional, Control Local, Muerte Neurológica y Neurocognición en los pacientes con enfermedad metastásica cerebral única con tumor primario controlado. Se realizó un estudio retrospectivo del tipo revisión sistemática cualitativa. Se incluyeron Ensayos Clínicos Aleatorizados que compararon la Cirugía (con o sin Radioterapia Holocraneal), con la Radiocirugía (con o sin Radioterapia Holocraneal) en la Enfermedad Metastásica Cerebral Única independientemente de la localización del tumor primario. La búsqueda encontró inicialmente 971 artículos, de ellos 19 Ensayos Clínicos Aleatorizados. Al aplicar la herramienta de riesgo de sesgos de Cochrane se derivó una muestra de 14 Ensayos Clínicos que presentaron bajo riesgo de sesgos. La combinación de RQ y RTH ofreció mayor SG que la RTH sola. La combinación de RTH y RC ofreció un mejor CL que la RQ y RTH. La combinación de RTH Y RC ofreció un mejor CL y SG que la RTH sola. No se encontraron diferencias significativas entre la RTH y RC versus RC sola. Los resultados en cuanto a la neurocognición y SIF fueron inconsistentes. El tratamiento óptimo de los pacientes con EMC aún no está bien definido constituyendo aún un tema controvertido.
The treatment of Isolated Cerebral Metastatic Disease is both multimodal and palliative. At present, the optimal treatment protocol is unknown. The objective of the present study was to determine outcome differences between Whole Brain Radiotherapy (WBRT), Radiosurgery (RS), and Surgical Resection (SR) or a combination of them, regarding Global Survival, Functional Independent Survival, Local Control, Neurological Death & Cognitive Status in patients with a unique cerebral metastasis and a controlled primary tumor. A retrospective study with a systematic qualitative literature review was performed. Randomized clinical trials comparing surgery (with or without whole brain radiotherapy), disregarding the localization of the primary tumor, were searched, resulting in 971 studies, only 19 of them being randomized. After applying Cochrane´s Risk of Bias Tool, only 14 studies showed a low risk of bias. The combination of SR & WBRT showed a longer survival, while WBRT & RS showed a better local control when compared with SR & WBRT. No statistical differences where found between WBRT & RS versus RS alone. Results regarding Cognitive Status & Functional Independent Survival were inconsistent. The optimal treatment in Isolated Metastatic Cerebral Disease still remains controversial.