• Jun-Ke Wang, Fei Su, Wen-Jie Ma, Hai-Jie Hu, Qin Yang, Fei Liu, Quan-Sheng Li, and Fu-Yu Li.
• aDepartment of Biliary Surgery bDepartment of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
• Medicine (Baltimore). 2017 Nov 1; 96 (46): e8793.

RationalPrimary malignant melanoma of the gallbladder is an extremely rare tumor, with fewer than 40 cases reported in the literature worldwide. The majority of patients presented as a solitary lesion in the gallbladder. To our knowledge, only one case of primary malignant melanoma of the gallbladder with multiple metastases has been reported, which involved the stomach, duodenum, pancreas, jejunum and a mesenteric lymph node.Patient ConcernsWe report a case of primary malignant melanoma of the gallbladder with metastases to the duodenal bulb, right adrenal and a celiac lymph node.DiagnosesPrimary malignant melanoma of the gallbladder with multiple metastases.InterventionsGastrojejunostomy, cholecystectomy, and biopsy of the three metastatic lesions were performed. Histopathologic examination revealed melanin pigments were within the tumor cells of the four lesions, however, junctional activity was noted only in the gallbladder, supporting that the gallbladder was the primary site. No pigmented lesions were detected on the skin or eyes. The postoperative recovery was uneventful, and subsequently, chemotherapy with paclitaxel and carboplatin was administered.OutcomesThe patient survived for 16 months due to tumor. progression.LessonsThe current case was unique due to the adrenal involvement. For patients with multiple metastases of malignant melanoma, gallbladder origin should be considered in the differential diagnosis from cutaneous origin.

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