RT Journal
A1 Chan JL, Silberman H
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD September 1
VO 147
IS 9
SP 887
OP 887
DO 10.1001/archsurg.2011.1267a 10.1001/archsurg.2011.1267b
UL http://dx.doi.org/10.1001/archsurg.2011.1267a 10.1001/archsurg.2011.1267b
AB 
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.