Breast carcinoma with metastasis to the gallbladder: an unusual case report with a short review of literature

Gallbladder metastases are very rare and usually arise from malignant melanoma, renal cell carcinoma and cervical carcinoma. Breast carcinoma metastatic to the gallbladder is extremely rare and only 4 cases have been reported in the English literature. We hereby report a 54-year-old lady who was diagnosed as having breast carcinoma and underwent modified radical mastectomy. One month after the operation, she developed acute abdominal pain and underwent cholecystectomy after clinical investigation. Histopathological examination revealed metastasis to the gallbladder. Being considered a patient with metastatic breast carcinoma she was subjected to taxane and anthracycline-based palliative chemotherapy. Later she had CNS involvement and died of the progressive disease soon after few months.     

Simultaneous breast and ovarian metastasis from gallbladder carcinoma

BACKGROUND:Gallbladder carcinoma is a common malignancy in the Indian subcontinent.It commonly metastasizes through lymphatics,direct invasion,and hematogenous spread.A common extra-abdominal site of metastasis is the lungs.Simultaneous metastasis to breast and ovary is extremely rare.METHOD:This report describes an unusual case of carcinoma gallbladder metastasizing to the breast and ovary at the same time.RESULTS:A 45-year-old woman came to us with complaints of flatulent dyspepsia associated with weight loss and anorexia.Ultrasound of the abdomen revealed hepatomegaly with thick-walled gallbladder with multiple stones and a mass at the fundus,but normal uterus and ovary.Contrast-enhanced computer tomography of the abdomen showed a gallbladder mass infiltrating the liver parenchyma.The patient underwent radical cholecystectomy.Histopathological examination revealed a poorly-differentiated adenocarcinoma with margins free from tumor infiltration.One month after surgery she developed a breast lump.Ultrasound of the abdomen for metastatic workup revealed an ovary mass.Simple mastectomy and salphingo-opherectomy were performed,and histopathological examination revealed a metastatic adenocarcinoma.The patient is now on chemotherapy with gemcitabin.CONCLUSION:This is an unusual case of carcinoma of the gallbladder with metastasis to the breast and ovary,which has not been documented before.     

Postoperative isolated splenic metastasis from gallbladder cancer: report of a case

We present a rare case of metachronous splenic metastasis from gallbladder cancer. A 65-year-old female with gallbladder cancer underwent a partial hepatectomy with en-bloc resection of the gallbladder and extrahepatic bile duct. Ten months later, she presented with isolated splenic metastasis and underwent splenectomy with distal pancreatectomy. The histological diagnosis confirmed metastatic adenocarcinoma from gallbladder cancer. She had no signs of recurrence 4 years after the second surgery. To the best of our knowledge, this is the first report of isolated splenic metastasis from gallbladder cancer.     

Cardiac metastasis from squamous cell carcinoma of gallbladder

A 65-year-old woman was admitted to our hospital with the diagnosis of gallbladder tumor. Right extended hepatic lobectomy plus lymph node dissection of the hepatoduodenal ligament and left hepaticojejunostomy with Roux-en-Y reconstruction was performed in July, 1993. The gallbladder tumor was histologically proven to be squamous cell carcinoma. Seventeen months later, the patient experienced dyspnea and pitting edema of the lower legs and was admitted, in December 1994, with a diagnosis of heart failure. Despite intensive cardiac support, she died 12 days after the second admission. Autopsy revealed multiple cardiac tumors in the left and right ventricles, left atrium, left coronary artery, and left diaphragm. Histologically, these tumors were shown to be squamous cell carcinoma, considered to have metastasized from the primary gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma nor any lymph node metastasis was found, the cardiac metastasis of the gallbladder carcinoma may have occurred via the hematogenous route. Although rare, this route of cardiac metastasis of gallbladder carcinoma may be an important aspect of distant metastasis, which should be monitored for during follow-up after resection of the primary tumor.     

Metastatic carcinoma of the gallbladder from renal cancer presenting as intraluminal polypoid mass

Summary We report a rare case of secondary involvement of the gallbladder by metastatic renal cell carcinoma. A 71-year-old man was diagnosed as having a polypoid mass within the gallbladder when he underwent right nephrectomy for a renal cell carcinoma. A preoperative diagnosis of simultaneous carcinoma of the gallbladder was made, and extended cholecystectomy with regional lymphadenectomy was performed five months after the initial operation.Postoperative histological examination of the polypoid mass within the gallbladder and a pancreatic mass excised during the second surgery revealed these resected tumors to be identical to the clear cell type of renal cell carcinoma. We feel that this case presents synchronous involvement of the gallbladder and pancreas by metastatic renal cell carcinoma of the right kidney.     

Tumeur neuroendocrine de la vésicule biliaire avec métastases hépatiques et pulmonaires: à propos d’un cas

Neuroendocrine tumours of the gallbladder are rare. They have been classified as carcinoide tumor and endocrine cell carcinoma. The primary treatment of neuroendocrine carcinoma of gallbladder remains surgery. They are aggressive tumours with poor prognosis. We report the case of a 54-year-old woman with a gallbladder mass with pulmonary and liver metastases. Fine needle biopsy of these revealed neuroendocrine carcinoma. There was no evidence of any other primary site. The patient was treated symptomatically; she died within two months of discharge fromthe hospital.     

Primary undifferentiated spindle-cell carcinoma of the gallbladder presenting as a liver tumor

Undifferentiated spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare. There is very little information available regarding the characteristics and treatment of this disease. We herein report the unique case of a 76-year-old female patient with a primary SpCC of the gallbladder that presented as a liver tumor. Preoperative radiologic examinations showed a 5-cm liver tumor around the gallbladder bed, and irregular thickening of the gallbladder wall. The patient underwent en-bloc resection of the gallbladder and segments 4b and 5 of the liver (including the liver tumor). Microscopic findings revealed that both lesions consisted mainly of a sarcomatous spindle-shaped component. Small foci of well-differentiated adenocarcinoma cells were identified in the gallbladder mucosa. There was a gradual transition between the two different components, thereby implying that these two cell types had a common origin. Immunohistochemical studies showed that the spindle-shaped cells were epithelial in nature. The patient's postoperative course was uneventful. However, she died of recurrent liver disease 6 months after the surgery. In conclusion, we surmised that the sarcomatous spindle cells originated from a carcinomatous component in the gallbladder mucosa through dedifferentiation. Further studies are needed to better understand the characteristics of this deadly tumor, and to establish an effective therapy for it.     

Surgical therapy and prognosis of sarcomatoid carcinoma of the gallbladder

BACKGROUND:Sarcomatoid carcinoma of the gallbladder is rare and its characteristics are poorly understood.This study aimed to understand the behavior and prognosis of sarcomatoid carcinoma of the gallbladder as well as its clinical manifestations and survival rate of patients after radical or palliative surgery,and to review the reported data worldwide and our 10 patients. METHODS:From 2004 to 2009,ten patients were pathologically diagnosed with sarcomatoid carcinoma of the gallbladder and underwent operati...     

Gallbladder carcinoma with osteoclast-like giant cells

Extraskeletal tumors containing multinucleated, osteoclast-like giant cells (OGCs) are uncommon. These neoplasms are most frequently reported in the breast and pancreas. Recently, some authors have suggested that carcinomas containing OGCs may represent a distinct clinicopathological entity with a more favorable prognosis. Occurrence in the gallbladder is extremely rare, with only one previous case. We report here on an additional case of gallbladder carcinoma with an infiltrate of OGCs. A 72-year-old woman presented with postprandial abdominal pain and was found to have a mass in the body of the gallbladder with direct liver invasion. Histological examination showed an adenosquamous carcinoma with an infiltrate of benign OGCs. Immunohistochemical analysis demonstrated that the giant cells were of histiocytic origin. The patient survived for 6 years without evidence of recurrence. This case adds to a small body of literature on gallbladder carcinoma with OGCs. Further studies are required to clearly define the prognostic significance of these giant cells in gallbladder cancer and the differences between adenosquamous carcinoma with OGCs and other gallbladder carcinomas (such as adenocarcinoma and squamous cell carcinoma) with those cells.     

Radical surgery for advanced squamous cell carcinoma of the gallbladder: a report of three cases, including a 10-year survivor

We report three patients who underwent radical resections for advanced squamous cell carcinoma of the gallbladder, two of whom are still alive without recurrence 10 and 9 years after surgery. The other patient, who had lymph node involvement, suffered recurrence of the disease and died 9 months after surgery. Our experience indicates that radical surgery can sometimes provide a chance for long-term survival in patients with this neoplasm. Lymph node metastasis, albeit a rare event, might be a poor prognostic factor in patients with this type of gallbladder carcinoma.     

Early Carcinoma of the Gallbladder, Noninvasive Carcinoma Originating in the Rokitansky-Aschoff Sinus: A Case Report

A patient was reported who underwent cholecystectomy under the diagnosis of chronic cholecystitis with calculi and adenomyomatosis, but it proved to be an early carcinoma of the gallbladder originating in and limited to the Rokitansky-Aschoff sinus (cyst-like structure). Early carcinoma of the gallbladder in this category is rare and this case report may be the first one in the literature.     

Bilateral Inflammatory Breast Cancer That Developed Two Years after Treatment for Triple-negative Breast Cancer

A 66-year-old woman underwent partial mastectomy and a sentinel lymph node biopsy for left breast cancer; the pathological diagnosis was invasive ductal carcinoma (pT1aN0, pStage I, triple-negative subtype). Postoperative radiotherapy was performed. Two years later, she developed redness and induration at both breasts. The diagnosis was bilateral inflammatory breast cancer. After four cycles of dose-dense epirubicin and cyclophosphamide followed by 12 weekly paclitaxel cycles, bilateral total mastectomy and axillary lymph node dissection were performed. At the one-year follow-up after undergoing operation and radiotherapy, she remained alive without recurrence. Dose-dense treatment regimens may help patients achieve complete resection without short-term recurrence.     

Metastatic gallbladder cancer presenting as a gingival tumor and deep neck infection

Gallbladder cancer has an extremely poor prognosis because it is often diagnosed at an advanced stage. We describe a 63-year-old woman who was treated 4 years previously for gallbladder cancer, with laparoscopic cholecystectomy and secondary hepatectomy after presenting with acute cholecystitis and gallbladder rupture. At her second presentation, she had a left lower gingival tumor and deep neck infection. Incision and drainage and tumor biopsies were performed, and pathology at both sites revealed adenocarcinoma. Positron emission tomography revealed other tumors in the left breast and left lower lung field, which were both proven to be adenocarcinoma by biopsy. The patient's presentation with a metastatic oral tumor was rare. Although the incidence is very low, physicians should consider the possibility of metastatic cancer in a patient with a history of cancer, who presents with new oral tumor or deep neck infection.     

Papillary carcinoma of the gallbladder and anomalous pancreatico-biliary junction. Report of three cases and review of the literature

BACKGROUND/AIMS: Papillary carcinoma of the gallbladder is less invasive, less frequently metastasizes and results in a longer survival than other gallbladder tumors. It is frequently associated with Anomalous Pancreatico-biliary junction (APBJ), a malformation that occurs most frequently in Japan. Consequently, most cases of papillary cancer have been reported in the Japanese literature, while the incidence of this neoplasm, and its association with APBJ, is still unknown in Western Countries. METHODOLOGY: Seventy cases of gallbladder cancer, observed between January 1992 and December 2000, were retrospectively evaluated. All the histological sections and available cholangiograms were reviewed. RESULTS: Three cases of papillary carcinoma were found (4.2%); APBJ was detected in one of these. All patients underwent resection and are long-term survivors; one patient developed, three years later, a papillary cancer of the common bile duct and was treated by Whipple's procedure. CONCLUSIONS: This study provides evidence that papillary carcinoma is more rare in Western countries than in Japan and it is characterized by a longterm survival after surgical resection. Further studies and reports are necessaries to define if this different incidence can justify differences between Western and Japanese results after surgery for gallbladder cancer.     

Unexpected bile duct carcinoma presenting with port-site metastasis after laparoscopic cholecystectomy for cholecystolithiasis

On March 1, 1999, a 71‐year‐old woman was diagnosed as having cholecystolithiasis, for which she underwent laparoscopic cholecystectomy at a local hospital. Intraoperative cholangiography was not performed. No malignant lesion was detected in the gallbladder. In March 2000, a subcutaneous tumor was pointed out at the port site in her abdomen, and resected. Histological examination revealed metastatic adenocarcinoma. On detailed examination, endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor, about 2 cm in diameter, in the lower bile duct. On June 1, she underwent pylorus‐preserving pancreatoduodenectomy at our institute, and several disseminated lesions were detected at the port site and in the abdominal cavity. There have been few reports of bile duct carcinoma that developed peritoneal dissemination caused by leakage of bile during cholecystectomy. Leakage of bile should be prevented during laparoscopic cholecystectomy, even in patients not diagnosed as having cancer preoperatively.     

Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.     

CT检查对诊断胆囊腺肌症的效能分析*

目的 总结胆囊腺肌症与胆囊癌患者多层螺旋CT(MSCT)表现特征。方法 2015年9月～2020年9月我院诊治的胆囊腺肌症患者113例和胆囊癌患者78例,均接受MSCT和超声检查,外科手术治疗后行组织病理学检查。结果 MSCT检查结果与术后组织病理学检查结果的一致性(Kappa=0.749)显著高于超声检查(Kappa=0.577);MSCT诊断胆囊腺肌症的准确度为88.0%,显著高于超声检查的79.6%(P<0.05);MSCT对局限型胆囊腺肌症的检出率为97.1%,显著高于超声检查的82.9%(P<0.05);在CT检查上,胆囊腺肌症表现为胆囊壁光滑、RAS窦和肝胆交界清楚显示率分别为36.3%、36.3%和69.0%,显著高于胆囊癌组的9.0%、6.4%和38.5%(P<0.05)。结论 MSCT检查诊断胆囊腺肌症有较高的正确率,其特征有助于与胆囊癌鉴别。     

Gallbladder adenosquamous cell carcinoma: report of two cases

Adenocarcinoma is the usual histological presentation of the very rare gallbladder carcinoma. Adenosquamous cell carcinoma accounts for less than 3.5% of gallbladder carcinomas, and is characterised by invasive growth, a reduced tendency for lymph node metastasis, an increased tendency for hepatic infiltration or liver metastasis, and a poorer prognosis than adenocarcinoma. We present two cases. The first patient presented to our institution with increased bilirubin levels and dilated intra- and extrahepatic bile ducts. Adenosquamous carcinoma of the gallbladder was diagnosed on the post-operative pathological specimen. After surgery, bilirubin levels decreased, but hepatic metastases occurred that did not respond to conventional chemotherapy. The second patient was admitted to our hospital with jaundice and abdominal pain. Abdominal computed tomography (CT) imaging showed marked thickening of the gallbladder with direct extension of a mass into the left liver lobe. Cytology specimens obtained with an endoscopic retrograde cholangiopancreatography (ERCP) procedure revealed a malignant epithelial tumour. The patient underwent surgery but the tumour was incompletely resected. A regimen of oral UFT (Tegafur + uracil) chemotherapy was begun. Serum bilirubin levels increased due to occlusion in the surgical area 15 weeks after the start of chemotherapy.     

Primary liposarcoma of gallbladder diagnosed by preoperative imagings： A case report and review of literature

A 49-year-old Japanese woman was referred to our department because of high fever and a huge abdominal mass. Computed tomography (CT) and magnetic resonance (MR) imagings revealed a tumor, about 30 cm in diameter, occupied the right hepatic lobe and the peritoneal cavity. Abdominal angiography showed that the tumor was fed mainly by the cystic artery. We pre-operatively diagnosed angiosarcoma of the gallbladder and performed tumor resection with cholecystectomy because the tumor was almost casplated, however the posterior wall of the gallbladder attached to the tumor firmly. Histologically, the tumor was composed of spindle cells including lipoblasts with cellular pleomorphism, which were also detected in the muscular layer of the gallbladder. We finally diagnosed pleomorphic liposarco-ma of the gallbladder. At 10 mo and 29 mo after the first operation, she underwent two more operations because of recurrence. Now she has a good quality of life 3 years and 6 mo after the first operation.     

Gallbladder carcinoma as an incidental finding]

Between March 1982 and December 1990, 903 patients underwent elective cholecystectomy. In 40 patients cholecystectomy was performed for gallbladder carcinoma. 15 malignomas (1.7%) were found incidentally. Preoperatively no anamnestic or diagnostic tumor signs were found in this group of patients. An en-bloc-resection of the gallbladder with resection of the bordering liver segments was performed when gallbladder carcinoma was diagnosed intraoperatively. When the diagnosis was established by postoperative histology, a relaparotomy with liver resection and lymphnode-dissection was done, except in one case (T-1a stage). Histology showed adenocarcinoma in 11 out of 15 cases. No significant difference in the course of the disease was observed in patients with gallbladder carcinoma of different types. The hospital mortality rate was 0% after curative and palliative surgical treatment of gallbladder carcinoma. Patients with T-1 and T-2 stage have survived without tumor-recurrence up to now. The median survival time after surgery for gallbladder carcinoma in T-3 stage was 17 months, and 8 months in T-4 stage. The morbidity rate after elective cholecystectomy is low and hospital mortality is 0%. According to the short survival times in advanced stages of gallbladder carcinoma, a prompt cholecystectomy in symptomatic gallbladder lithiasis or chronic cholecystitis is advocated.