0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Quiz Case FREE

Joshua L. Chan, MD; Howard Silberman, MD
[+] Author Affiliations

Author Affiliations: Department of Surgery, University of Southern California, Los Angeles.


Arch Surg. 2012;147(9):887. doi:10.1001/archsurg.2011.1267a.
Text Size: A A A
Published online

A 63-year-old man had a history of stage IV metastatic melanoma arising from the back and subsequently metastatic to the cervical nodes, brain, and stomach. Metastatic lesions were managed with chemobiotherapy, interleukin 2, gamma-knife radiotherapy, and partial gastrectomy, rendering the patient free of disease for 8 years. Surveillance staging revealed lesions on his gallbladder with increased signal on positron emission tomography. Computed tomography demonstrated abnormal frondlike gallbladder wall nodularity with eccentric masses within the gallbladder lumen (Figure 1). The patient remained asymptomatic at this time. At cholecystectomy, the gallbladder was distended but had no external abnormalities. However, diffuse superficial mucosal nodularity was observed. More than 85% of the gallbladder mucosal surface was covered with more than 100 tan to black irregularly shaped polypoid lesions that ranged from 0.2 to 1.5 cm in diameter (Figure 2). Areas of grossly unaffected gallbladder mucosa were tan and velvety. The patient tolerated the procedure and recovered without incident.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Computed tomographic scan of the abdomen demonstrating multiple intraluminal masses (arrow) arising from the gallbladder wall.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Gross specimen of the gallbladder, weighing 124.9 g and measuring 13.0 × 6.4 × 4.1 cm. No specific lesions or ulcerations were seen on the serosal surface. The gallbladder contained more than 50 small black multifaceted stones, varying from 0.1 to 0.2 cm in diameter. More than 85% of the gallbladder mucosal surface was covered with approximately 100 tan to black irregularly shaped polypoid lesions ranging from 0.2 to 1.5 cm in diameter. To convert inches to centimeters, multiply by 2.54.

WHAT IS THE DIAGNOSIS?

A. Cholelithiasis

B. Metastatic melanoma to the gallbladder

C. Primary adenocarcinoma

D. Gallbladder polyps

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Computed tomographic scan of the abdomen demonstrating multiple intraluminal masses (arrow) arising from the gallbladder wall.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Gross specimen of the gallbladder, weighing 124.9 g and measuring 13.0 × 6.4 × 4.1 cm. No specific lesions or ulcerations were seen on the serosal surface. The gallbladder contained more than 50 small black multifaceted stones, varying from 0.1 to 0.2 cm in diameter. More than 85% of the gallbladder mucosal surface was covered with approximately 100 tan to black irregularly shaped polypoid lesions ranging from 0.2 to 1.5 cm in diameter. To convert inches to centimeters, multiply by 2.54.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections