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Cocco G, Delli Pizzi A, Basilico R, Fabiani S, Taraschi AL, Pascucci L, Boccatonda A, Catalano O, Schiavone C. Imaging of gallbladder metastasis. Insights Imaging 2021; 12:100. [PMID: 34259932 PMCID: PMC8280258 DOI: 10.1186/s13244-021-01049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/13/2021] [Indexed: 12/29/2022] Open
Abstract
Gallbladder metastasis (GM) is a rare condition, often with a late diagnosis or detected upon autopsy. There is no extensive literature on the imaging diagnosis of GM. Here we present a comprehensive review of the literature with the aim of helping to interpret the clinical findings and imaging features of such patients. Few studies on GM are reported in literature. GM by melanoma accounts for about 55.6% of cases. The remaining cases origin from breast cancer (13.6%), hepatocellular carcinoma (13.6%), renal cell carcinoma (6.8%), lung cancer (4.5%), lymphoma (3.5%) and gastric cancer (2.4%). The most common clinical presentation of GM is abdominal pain from cholecystitis due to obstruction of the cystic duct. The main ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) findings that clinicians and radiologists should consider in their everyday medical activity were discussed. The diagnosis of GM was often achieved through a combination of more than one imaging modality. In more than 90% of cases, the diagnosis of GM is often late and combined with other organs involvement in the terminal stage of the malignancy. The knowledge of the clinical features and different imaging techniques through careful evaluation of the gallbladder can help to achieve early diagnosis and avoid misdiagnosis or false negative results.
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Affiliation(s)
- Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G.D'Annunzio" University, Chiety, Italy.
| | - Andrea Delli Pizzi
- Department of Neurosciences, Imaging and Clinical Studies, "G.D'Annunzio" University, Chiety, Italy
| | - Raffaella Basilico
- Department of Neurosciences, Imaging and Clinical Studies, "G.D'Annunzio" University, Chiety, Italy
| | - Stefano Fabiani
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G.D'Annunzio" University, Chiety, Italy
| | - Alessio Lino Taraschi
- Department of Neurosciences, Imaging and Clinical Studies, "G.D'Annunzio" University, Chiety, Italy
| | - Luca Pascucci
- Department of Neurosciences, Imaging and Clinical Studies, "G.D'Annunzio" University, Chiety, Italy
| | - Andrea Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G.D'Annunzio" University, Chiety, Italy
| | | | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G.D'Annunzio" University, Chiety, Italy
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2
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Simultaneous Metastasis of the Pancreas and Gallbladder from Renal Cell Carcinoma. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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3
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Acute cholecystitis caused by gallbladder metastasis from non-small cell lung cancer: a case report. Clin J Gastroenterol 2021; 14:351-357. [PMID: 33495974 DOI: 10.1007/s12328-020-01293-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 12/07/2022]
Abstract
Although non-small cell lung cancer can metastasize to any part of the body, metastasis to the gallbladder is extremely rare. We present a case of acute cholecystitis caused by gallbladder metastasis from non-small cell lung cancer. A 66-year-old man diagnosed with primary stage IV T4N3M1b non-small cell lung cancer was admitted to our hospital to receive chemotherapy, during which he presented with right upper abdominal pain. Abdominal contrast-enhanced computed tomography showed an enhanced mass at the neck of the gallbladder and gallbladder distension with obvious wall thickening. Acute cholecystitis caused by obstruction of the gallbladder neck by malignancy was suspected. Open cholecystectomy, extrahepatic bile duct resection, and Roux-en-Y choledochojejunostomy were performed. Pathological and immunohistochemical examinations revealed gallbladder metastasis originating from non-small cell lung cancer. In conclusion, when a patient with lung cancer presents with acute cholecystitis, the rare possibility of gallbladder metastasis should be considered.
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Zouari S, Ben Othmen M, Abdessayed N, Larbi Mama N, Jarrar MS, Sriha B, Mokni M, Jaidane M, Hmida W. Metastatic renal clear cell carcinoma mimicking a gallbladder polyp: Case report and literature review. Int J Surg Case Rep 2019; 64:133-138. [PMID: 31655282 PMCID: PMC6818339 DOI: 10.1016/j.ijscr.2019.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 12/27/2022] Open
Abstract
Metastases to gallbladder from renal cell carcinoma are very rare. Most of the cases are diagnosed incidentally, and both clinical presentation and physical examination are unspecific. Imaging although its specificity can’t make the difference between primary gallbladder carcinoma and metastasis from RCC. Only pathological examination of the specimen after cholecytectomy with immunochemistery can assess the diagnosis.
Introduction Metastatic tumors to the gallbladder are uncommon. Metastases from renal cell carcinoma (RCC) to the gallbladder are exceptional. Frequencies of less than 0.6% reported in large autopsy reviews and few cases have been reported in the literature. Presentation of case Herein we present a case of a 50-year-old man that developed four years after radical nephrectomy for RCC, a gallbladder metastasis, discovered incidentally on Computed Tomography (CT) scan. It was described as an intraluminal gallbladder polyp. Radiological features were very suggestive of primary gallbladder carcinoma, thus the patient had a laparoscopic cholecystectomy. The pathological examination of the surgical specimen concluded to a RCC metastasis. Immunochemistry with vimentin and pancytokeratin were supportive of this diagnosis. The clinical course was uneventful after 18 months period of follow up. Discussion At the time of presentation, almost one-third of the patients with RCC are metastatic. Metastases to the gallbladder are extremely rare. Clinical presentation and physical examination are unspecific. Radiological findings can raise information and orient the diagnosis although the difference between both diagnoses remains difficult. Usually, it is a pedunculated and not associated with gallstones with enhancement on CT scan. The treatment remains surgical with R0 cholecystectomy, and prognosis is mainly related to disease free interval and single site metastasis. Conclusion We highlight here the challenge to make the difference between a primary gallbladder carcinoma and metastasis from RCC. Diagnosis is made on pathological examination and immunochemistry.
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Affiliation(s)
- Skander Zouari
- Sahloul Hospital, Department of Urology, Route de la ceinture, Hammam Sousse, 4011, Sousse, Tunisia
| | - Mouna Ben Othmen
- Sahloul Hospital, Department of Urology, Route de la ceinture, Hammam Sousse, 4011, Sousse, Tunisia
| | - Nihed Abdessayed
- Farhat Hached Hospital, Department of Histopathology, Ibn El Jazzar Road, Sousse Ezzouhour, 4031, Sousse, Tunisia; Research Lab: Transfer in Technology in Anatomic Pathology (LR12SP08), Tunisia.
| | - Nadia Larbi Mama
- Sahloul Hospital, Department of Radiology, Route de la ceinture, Hammam Sousse, 4011, Sousse, Tunisia
| | - Mohamed Salah Jarrar
- Farhat Hached Hospital, Department of General Surgery, Ibn El Jazzar Road, Sousse Ezzouhour, 4031, Sousse, Tunisia
| | - Badreddine Sriha
- Farhat Hached Hospital, Department of Histopathology, Ibn El Jazzar Road, Sousse Ezzouhour, 4031, Sousse, Tunisia; Research Lab: Transfer in Technology in Anatomic Pathology (LR12SP08), Tunisia
| | - Moncef Mokni
- Farhat Hached Hospital, Department of Histopathology, Ibn El Jazzar Road, Sousse Ezzouhour, 4031, Sousse, Tunisia; Research Lab: Transfer in Technology in Anatomic Pathology (LR12SP08), Tunisia
| | - Mehdi Jaidane
- Sahloul Hospital, Department of Urology, Route de la ceinture, Hammam Sousse, 4011, Sousse, Tunisia
| | - Wissem Hmida
- Sahloul Hospital, Department of Urology, Route de la ceinture, Hammam Sousse, 4011, Sousse, Tunisia
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Saito Y, Okuda H, Yoshida M, Okimasa S, Fukuda T, Yano M, Ochi M, Okamoto Y, Nakayama H, Ono E, Ohdan H. Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report. J Med Case Rep 2018; 12:162. [PMID: 29855393 PMCID: PMC5977495 DOI: 10.1186/s13256-018-1569-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature. Case presentation A 75-year-old Japanese (Asian) woman presented for further evaluation of a gallbladder polyp, 15 years after right radical nephrectomy for renal cell carcinoma. Computed tomography revealed a 12 mm enhancing pedunculated tumor in the gallbladder fundus. Open simple cholecystectomy was performed and the tumor was histologically confirmed as a metastasis of renal cell carcinoma to the gallbladder. Our patient is alive and has been disease-free for 3 years after cholecystectomy. Conclusions Although metastasis of renal cell carcinoma is a rare differential diagnosis of gallbladder tumors, simple cholecystectomy is likely to offer a chance of long-term survival for patients with gallbladder metastases of renal cell carcinoma.
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Affiliation(s)
- Yasufumi Saito
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan.
| | - Hiroshi Okuda
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Makoto Yoshida
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
| | - Seiji Okimasa
- Department of Palliative Care, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
| | - Masatsugu Yano
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
| | - Makoto Ochi
- Department of Dialysis Surgery, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan
| | - Yuzo Okamoto
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
| | - Hirofumi Nakayama
- Department of Pathology and Laboratory Medicine, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan
| | - Eiji Ono
- Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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6
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Kitamura H, Kurokawa M, Inaki N, Bando H. Gallbladder Metastasis from Renal Cell Carcinoma. Indian J Surg 2017; 80:278-280. [PMID: 29973761 DOI: 10.1007/s12262-017-1705-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022] Open
Abstract
We experienced a rare case of gallbladder metastasis from renal cell carcinoma. A 68-year-old man was admitted for further evaluation of a gallbladder tumor, which had been identified on follow-up computed tomography after partial nephrectomy for renal cell carcinoma. Enhanced computed tomography and magnetic resonance imaging showed an enhancing polypoid mass in the gallbladder lumen. Endoscopic ultrasonography demonstrated a homogenous hypo-echoic polypoid lesion, and the outer hyper-echoic layer of the adjacent wall was intact. Blood flow signals in the wall side of the mass were observed on color Doppler endoscopic ultrasonography images. Laparoscopic cholecystectomy was performed and he was uneventfully discharged. Macroscopic examination of the specimen revealed a 12 × 7 × 5 mm pedunculated tumor attached by a thin pedicle to the fundus of the gallbladder. Histology confirmed a metastasis of the renal cell carcinoma that had infiltrated the shallow subserosa but had mainly grown into cavity of the gallbladder. These imaging findings are considered characteristic and may assist preoperative diagnosis in patients with a history of renal cell carcinoma.
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Affiliation(s)
- Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530 Japan
| | - Masaru Kurokawa
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530 Japan
| | - Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530 Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530 Japan
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7
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Lal H, Yadav P, Achar S, Singh UP. Renal cell carcinoma with isolated metastasis to sigmoid mesentery: a rare resectable combination. BMJ Case Rep 2017; 2017:bcr-2017-221826. [PMID: 28918405 DOI: 10.1136/bcr-2017-221826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal cell carcinoma accounts for 2%-3% of all malignancies in adults. It spreads via direct extension, lymphatic route as well as haematogenous route. Lymph nodes, lungs, bone, liver and brain are the usual sites for its metastatic spread. In the presence of limited metastatic disease with potentially resectable metastases, surgery offers the best chances of cure. In the present case, we describe a case of renal cell carcinoma with a solitary metastasis to the sigmoid mesentery in a patient with Von Hippel-Lindau syndrome. There was no retroperitoneal lymphadenopathy or tumour thrombus in the renal vein. The patient was managed with laparoscopic radical nephrectomy and excision of the sigmoid mesentery mass. At 6 months of follow-up, there is no evidence of recurrent disease.
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Affiliation(s)
- Hira Lal
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shashidhar Achar
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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8
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Shyr BU, Chen SC, Shyr YM, Lee RC, Wang SE. Metastatic polyp of the gallbladder from renal cell carcinoma. BMC Cancer 2017; 17:244. [PMID: 28376766 PMCID: PMC5379575 DOI: 10.1186/s12885-017-3243-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/29/2017] [Indexed: 12/28/2022] Open
Abstract
Background Gallbladder metastasis from renal cell carcinoma (RCC) is extremely rare. The purpose of this study is to clarify the characteristics of metastatic RCC to gallbladder. Methods The pooled data for analysis were collected from the case of metastatic RCC to gallbladder encountered by our institution along with sporadic cases reported in literature from 1991 to 2015. Results A total of 50 cases of metastatic RCC to gallbladder were recruited for study. Fifty-seven percentage of the primary RCC was from the right kidney and 43% from the left. The median interval between diagnoses of primary and metastatic RCC to gallbladder was 36 months, with the longest duration up to 324 months. Most (70%) were asymptomatic. The size of metastatic RCC to gallbladder ranged from 0.8 cm to 9 cm, with median of 2.6 cm. Majority (91%) of the metastatic RCCs presented as a polypoid mass with narrow stalk, and 82% were hypervascular lesion. The overall 1 year, 3 year and 5 year survival rate was 91.5%, 76.2% and 59.3% respectively, with a median of 26.5 months. Number of the metastatic site, timing of gallbladder metastasis, symptom, tumor size and operation type of cholecystectomy seemed to have no impact on survival. Conclusions Metastatic RCC to the gallbladder should be taken into account for a gallbladder polypoid mass with narrow hypervascular stalk during the diagnosis and/or follow-up of primary RCC. Gallbladder metastasis from RCC is not necessarily to be an advanced stage with poor outcome, and cholecystectomy is recommended whenever possible.
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Affiliation(s)
- Bor-Uei Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan
| | - Shih-Chin Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan
| | - Rheun-Chuan Lee
- Departments of Radiology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Shin-E Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
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9
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Gallbladder's clear cell renal carcinoma metastasis: A case report. Int J Surg Case Rep 2015; 18:48-51. [PMID: 26688513 PMCID: PMC4701866 DOI: 10.1016/j.ijscr.2015.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 12/28/2022] Open
Abstract
Contribute to the comprehension of rare mestatic disease in clear cell renal carcinoma. Underline that non only primary tumors develop in the gallbladder. Increasing suspect of metastatic disease in patients with renal cell carcinoma will improve medical care of this patients.
Introduction Clear cell renal cell carcinoma (ccRCC) is well known for its propensity to metastasize to unusual sites, even after 10 years. Gallbladder metastases are extremely rare, being found in approximately 0.6% of cases, at autopsy. Case presentation A 51-year-old man with a history of right ccRCC underwent total nephrectomy with extended lymphadenectomy, in another Hospital. Three years later, he was hospitalized at our Hospital, with gallbladder metastasis detected during a follow-up CT scan. At clinical examination, the patient did not present any symptoms or signs of gallbladder disease. Several imaging tests were performed to better characterize the lesion. A successful cholecystectomy and hepatic resection of 4b segment were performed, obtaining a R0 resection. The clinical course was uneventful, without any complications. After a 7-month follow-up, the patient is free from disease. Discussion A typical metastases are those located in a site other than thoracic, skeletal, hepatic, adrenal or encephalic tissue. Cholecystectomy with R0 resection has demonstrated to be the only factor increasing survival, mainly in isolated cases of metastasis, providing an overall 35–60% survival rate at 5 years. Conclusion In the follow-up of patients with a positive history of renal cell carcinoma specially clear cell subtype, all new finding should be taken into account as possible metastases. We ought to consider US and CT-scan behavior of gallbladder metastatic disease in order to orientate our diagnosis. Surgery for metastatic gallbladder disease of renal origin seems to be a feasible therapy which is capable of increasing patients’ overall survival.
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10
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Ueda I, Aoki T, Oki H, Takahashi H, Hayashida Y, Minagawa N, Yamaguchi K, Fujimoto N, Matsumoto T, Yamada S, Korogi Y. Gallbladder metastasis from renal cell carcinoma: a case report with review of the literature. Magn Reson Med Sci 2014; 14:133-8. [PMID: 25345408 DOI: 10.2463/mrms.2013-0130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We experienced a rare case of gallbladder metastasis from renal cell carcinoma (RCC). Ultrasound, computed tomographic, and magnetic resonance findings showed a hypervascular polypoid mass and correlated well with histopathologic findings. The mass showed high intensity on diffusion-weighted images, and the apparent diffusion coefficient was relatively low. These imaging findings are considered characteristic and may assist preoperative diagnosis in patients with history of RCC.
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Affiliation(s)
- Issei Ueda
- Department of Radiology, University of Occupational and Environmental Health School of Medicine
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11
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Win AZ. Renal Cell Carcinoma Metastasis to the Gallbladder Detected by FDG-PET/CT. J Clin Med Res 2014; 6:482-6. [PMID: 25247024 PMCID: PMC4169092 DOI: 10.14740/jocmr1886w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 12/17/2022] Open
Abstract
A 62-year-old male presented to the ER with three episodes of diffuse abdominal pain which occurred after eating. He had a history of renal cell carcinoma (RCC), prostate cancer and bladder cancer. FDG-PET/CT scan showed a hypermetabolic soft tissue density within the fundus of the gallbladder. The patient underwent laparoscopic cholecystectomy and surgical pathology revealed clear cell type RCC. This is the first report that features PET/CT imaging to detect RCC metastasis to the gallbladder. Lesions within the gall bladder and their clinical manifestations can be non-specific and PET/CT can help characterize them. RCC metastasis to the gallbladder is very rare but it should be included in the differential diagnosis, especially in patients with a history of RCC.
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Affiliation(s)
- Aung Zaw Win
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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12
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Hisa T, Takamatsu M, Shimizu T, Gibo N. Chronological changes in the ultrasonic findings of gallbladder metastasis from renal cell carcinoma: a case report and review. J Med Ultrason (2001) 2014; 41:371-5. [PMID: 27277913 DOI: 10.1007/s10396-013-0510-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
Abstract
The present case involves a gallbladder metastasis from renal cell carcinoma (GBMRCC). During 11 months of ultrasound follow-up examinations, the mass, covered with a highly echoic surface layer, exhibited the following changes: the wide base became constricted, the tumor surface became irregular, and the mass increased in diameter. A histopathological examination confirmed that the tumor cells were mainly present in the subepithelial layer, the gallbladder epithelium had ruptured, and necrotic debris covered the tumor surface. The highly echoic surface layer observed on the latest ultrasound images corresponded to the necrotic debris. These findings suggested that GBMRCCs initially develop in the subepithelial layer and then undergo expansive intraluminal growth. They subsequently cause the epithelium to rupture, resulting in necrotic debris appearing on the tumor surface.
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Affiliation(s)
- Takeshi Hisa
- Department of Internal Medicine, Saku Central Hospital, Usuda 197, Saku, Nagano, 384-0301, Japan.
| | - Masato Takamatsu
- Department of Internal Medicine, Saku Central Hospital, Usuda 197, Saku, Nagano, 384-0301, Japan
| | - Takehiro Shimizu
- Department of Internal Medicine, Saku Central Hospital, Usuda 197, Saku, Nagano, 384-0301, Japan
| | - Noriaki Gibo
- Department of Internal Medicine, Saku Central Hospital, Usuda 197, Saku, Nagano, 384-0301, Japan
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13
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Choi WS, Kim SH, Lee ES, Lee KB, Yoon WJ, Shin CI, Han JK. CT findings of gallbladder metastases: emphasis on differences according to primary tumors. Korean J Radiol 2014; 15:334-45. [PMID: 24843238 PMCID: PMC4023052 DOI: 10.3348/kjr.2014.15.3.334] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/15/2014] [Indexed: 12/22/2022] Open
Abstract
Objective To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors. Materials and Methods Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. Results The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. Conclusion Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.
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Affiliation(s)
- Won Seok Choi
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Eun Sun Lee
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Kyoung-Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Won Jae Yoon
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul 100-032, Korea
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
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14
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Jeong YS, Han HS, Lim SN, Kim MJ, Han JH, Kang MH, Ryu DH, Lee OJ, Lee KH, Kim ST. Gallbladder Metastasis of Non-small Cell Lung Cancer Presenting as Acute Cholecystitis. Chin J Cancer Res 2013; 24:249-52. [PMID: 23358590 DOI: 10.1007/s11670-012-0249-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 06/28/2012] [Indexed: 12/19/2022] Open
Abstract
Although non-small cell lung cancer (NSCLC) can metastasize to almost any organ, metastasis to the gallbladder with significant clinical manifestation is relatively rare. Here, we report a case of gallbladder metastasis of NSCLC presenting as acute cholecystitis. A 79-year-old man presented with pain in the right upper quadrant and fever. A computed tomography (CT) scan of the chest and abdomen showed a cavitary mass in the right lower lobe of the lung and irregular wall thickening of the gallbladder. Open cholecystectomy and needle biopsy of the lung mass were performed. Histological examination of the gallbladder revealed a moderately-differentiated squamous cell carcinoma displaying the same morphology as the lung mass assessed by needle biopsy. Subsequent immunohistochemical examination of the gallbladder and lung tissue showed that the tumor cells were positive for P63 but negative for cytokeratin 7, cytokeratin 20 and thyroid transcription factor-1. A second primary tumor of the gallbladder was excluded by immunohistochemical methods, and the final pathological diagnosis was gallbladder metastasis of NSCLC. Although the incidence is extremely rare, acute cholecystitis can occur in association with lung cancer metastasis to the gallbladder.
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Robledo AB, Millet SB, Orbis Castellanos JF, Montalvá Orón EM, Salom Fuster JV, DE Juan Burgueño M. Metastasis of the gallbladder in clear cell renal carcinoma. Oncol Lett 2012; 3:1136-1138. [PMID: 22783406 DOI: 10.3892/ol.2012.616] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/17/2012] [Indexed: 12/21/2022] Open
Abstract
Metastasis of the gallbladder due to renal cell tumors is rare. We present a case of gallbladder and metachronous left adrenal metastasis at six months follow-up, which demonstrates the importance of radiological tests and histology when making a definitive diagnosis. Clinical findings are not specific enough to arrive at a final diagnosis. However, immunohistochemistry is necessary to differentiate between primary and secondary metastatic tumors. Cholecystectomy should be performed to obtain a definitive diagnosis and to improve survival in cases of single lesions in the gallbladder.
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16
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Vashi PG, Abboud E, Gupta D. Renal cell carcinoma with unusual metastasis to the small intestine manifesting as extensive polyposis: successful management with intraoperative therapeutic endoscopy. Case Rep Gastroenterol 2011; 5:471-8. [PMID: 21960951 PMCID: PMC3180665 DOI: 10.1159/000331136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We present here a rare clinical case of a 53-year-old gentleman with metastasis from renal cell carcinoma (RCC) to the small intestine presenting with extensive polyposis and massive gastrointestinal bleeding which was successfully managed with intraoperative endoscopic polypectomy and segmental small bowel resection. The patient presented with melena 2 weeks after right nephrectomy for RCC. Capsule endoscopy found extensive polyposis throughout the small bowel, and the histological features confirmed the diagnosis of metastatic RCC. The patient eventually underwent laparotomy with intraoperative endoscopy of the entire small bowel. Most of the polyps were removed by snare polypectomy. Three segments of the small bowel with extensive transmural involvement had to be resected with primary anastomosis. In the 2 months following his surgery, the patient had no further evidence of gastrointestinal bleeding. The decision of meticulously removing close to 100 polyps by intraoperative endoscopy prevented the patient from requiring total small bowel resection and lifelong dependence on parenteral nutrition. In conclusion, gastrointestinal bleeding in a patient with known RCC should always trigger full gastrointestinal work-up including capsule endoscopy and, if necessary, double balloon enteroscopy.
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Affiliation(s)
- Pankaj G Vashi
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Zion, Ill., USA
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Khan ZS, Huth J, Kapur P, Huerta S. Indications and recommended approach for surgical intervention of metastatic disease to the gallbladder. World J Surg Oncol 2010; 8:80. [PMID: 20828420 PMCID: PMC2944133 DOI: 10.1186/1477-7819-8-80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 09/10/2010] [Indexed: 12/26/2022] Open
Abstract
Metastatic disease to the gallbladder is unusual. The most common malignancy metastatic to the gallbladder is melanoma, followed by renal cell carcinoma (RCC) and breast cancer. Due to the unusual nature of the disease, there are no trials available for review. Thus, the management for these patients has been based on institutional experience and review of case series. The indications for surgical intervention for melanoma are metastatic disease discrete to the gallbladder and biliary symptoms, which are uncommon for melanoma, but might occur due to cystic duct obstruction culminating in cholecystitis. Laparoscopic cholecystectomy without a lymphadenectomy is emerging as the preferred approach for this metastatic deposit. The vast majority of patients with metastases to the gallbladder from RCC carry a good prognosis and a laparoscopic cholecystectomy should be considered. Patients with metastases to the gallbladder from the breast classically present with biliary symptoms and commonly undergo a laparoscopic cholecystectomy, which invariably demonstrates a deposit in the gallbladder from lobular breast cancer. In the present report, we review the indications for surgical intervention from various malignancies metastatic to the gallbladder and the current consensus for the laparoscopic approach from the diverse metastatic deposits to the gallbladder.
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Affiliation(s)
- Zarrish S Khan
- Department of Surgery, UT Southwestern Medical Center, Harry Hines Blvd, Dallas, 75219, USA
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18
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Fang X, Gupta N, Shen SS, Tamboli P, Charnsangavej C, Rashid A, Wang H. Intraluminal polypoid metastasis of renal cell carcinoma in gallbladder mimicking gallbladder polyp. Arch Pathol Lab Med 2010; 134:1003-9. [PMID: 20586628 DOI: 10.5858/2009-0453-oa.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Metastatic renal cell carcinoma (RCC) in gallbladder is rare with only 18 cases published in the English literature. OBJECTIVES To review the clinicopathologic characteristics of metastatic RCC in gallbladder and to correlate the findings with clinical outcomes. DESIGN We report 4 additional cases of intraluminal polypoid metastasis of RCC in gallbladder and reviewed all reported cases, to our knowledge, of metastatic RCC in gallbladder in the English literature. RESULTS Most of the patients (19 of 22; 86%) were men. The ages at presentation ranged from 39 to 84 years with a median age of 61.5 years. All cases showed an intraluminal polypoid/pedunculated mucosal mass mimicking a gallbladder polyp. Histologically, all cases were clear cell RCC with most of the tumors either confined to gallbladder mucosa (67%) or involved both mucosa and muscular layer (27%). The longest interval between nephrectomy and the development of gallbladder metastasis was 27 years. CONCLUSIONS Metastatic clear cell RCC should be considered in the differential diagnosis of polypoid lesion of the gallbladder with clear cell morphology. Solitary metastasis of RCC in gallbladder correlated with better survival, and simple cholecystectomy for solitary metastatic RCC may provide patients with favorable long-term survival.
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Affiliation(s)
- Xueping Fang
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Shoji S, Mukai M, Yazawa N, Sekido Y, Nagata Y, Uchida T, Terachi T. Metastasis to gallbladder and adrenal gland of renal cell carcinoma. Oncol Lett 2010; 1:507-509. [PMID: 22966333 DOI: 10.3892/ol_00000089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 03/03/2010] [Indexed: 11/06/2022] Open
Abstract
We studied a case of metastasis to the gallbladder and left adrenal gland of clear cell-type renal cell carcinoma (RCC) in the right kidney. A polypoid gallbladder tumor and left adrenal mass were found 2 years after surgery for clear cell-type RCC in a 50-year-old man. The gallbladder tumor and left adrenal mass showed hypervascularity on diagnostic imaging. Systemic image screening showed no other metastatic lesion. Simple cholecystectomy and left adrenalectomy were performed. A histopathological examination showed tumor cells in a gallbladder polyp. Furthermore, based on various specific and immunohistochemical studies, the patient was pathologically diagnosed to have gallbladder and right adrenal gland metastasis of clear cell-type RCC.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University Hachioji Hospital, Tokyo
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Abstract
Renal-cell carcinoma is the most lethal of all urologic malignancies, with a high metastatic potential. Approximately 25% of patients present with stage IV disease, and up to 40% of patients have disease recurrence after nephrectomy. Computed tomography (CT) is an important imaging modality for initial diagnosis and restaging of this patient population. Although extremely rare, clear-cell renal carcinoma has been reported to metastasize to the gallbladder. We present the case of a 50-year-old man who developed clear-cell renal carcinoma metastases to the contralateral adrenal gland and the gallbladder that were detected at initial restaging with CT scan.
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