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Muszynska C, Lundgren L, Andersson R, Søland T, Lindell G, Sandström P, Andersson B. Incidental metastases and lymphoma of the gallbladder - an analysis of ten rare cases identified from a large national database. Scand J Gastroenterol 2019; 54:350-358. [PMID: 31035806 DOI: 10.1080/00365521.2019.1588363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The aim was to identify and characterize rare malignancies of the gallbladder, incidentally found at cholecystectomy, and describe the diagnostic work-up, treatment and outcome. Methods: Data from cholecystectomies during 2007-2014 registered in the Swedish Register for Gallstone Surgery (GallRiks) were analyzed for incidental cancer. For completion of the pathology report, data were linked with the Swedish Registry for Cancer in the liver and biliary tract (SweLiv) and/or the Swedish Cancer Registry. Results: From 36,355 patients that underwent cholecystectomy on a benign indication 215 cases of incidental gallbladder cancer (IGBC) were identified. In total seven patients with metastases to the gallbladder from different primary tumors (breast cancer, malignant melanoma, gastric cancer, renal cell carcinoma, upper gastrointestinal cancer, colon cancer and pancreatic cancer) and three patients with lymphoma involvement of the gallbladder were found. Most patients were female with no difference between the groups (8/10 versus 171/215). The median age for the metastasis and lymphoma (MOL) group was equal to the IGBC group, 70 (64-72) years versus 70 (63-78) years. All patients in the MOL group underwent preoperative imaging with ultrasound or computed tomography, on which no metastases were identified. In only two patients a tumor was seen by the surgeon during the perioperative examination of the gallbladder. The median survival was 5.8 months for MOL patients and 23 months for IGBC patients. Conclusion: Metastases and lymphoma of the gallbladder are rare. Traditional imaging methods prior to cholecystectomy may miss gallbladder malignancies. A liberal approach of histopathological analysis of the gallbladder should be applied.
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Affiliation(s)
- Carolina Muszynska
- a Department of Surgery , Skåne University Hospital , Lund , Sweden.,b Department of Clinical Sciences , Lund University , Lund , Sweden
| | - Linda Lundgren
- c Department of Surgery , County Council of Östergötland , Linköping , Sweden.,d Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden
| | - Roland Andersson
- a Department of Surgery , Skåne University Hospital , Lund , Sweden.,b Department of Clinical Sciences , Lund University , Lund , Sweden
| | - Torunn Søland
- e Department of Pathology , Østfold Hospital , Norway
| | - Gert Lindell
- a Department of Surgery , Skåne University Hospital , Lund , Sweden.,b Department of Clinical Sciences , Lund University , Lund , Sweden
| | - Per Sandström
- c Department of Surgery , County Council of Östergötland , Linköping , Sweden.,d Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden
| | - Bodil Andersson
- a Department of Surgery , Skåne University Hospital , Lund , Sweden.,b Department of Clinical Sciences , Lund University , Lund , Sweden
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Urade T, Oka S, Iimori S, Man-I M, Abe T, Sawa H, Iwatani Y, Morinaga Y, Kuroda D. A resected case of gallbladder metastasis with symptoms of acute cholecystitis in multiple metastatic ductal carcinoma of the breast. Clin J Gastroenterol 2018; 12:52-56. [PMID: 30109570 DOI: 10.1007/s12328-018-0892-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
Abstract
Gallbladder metastasis from breast cancer, especially from ductal carcinoma, is rare. Herein, we report a rare case of gallbladder metastasis from ductal carcinoma of the breast that was diagnosed after laparoscopic cholecystectomy (LC) for acute cholecystitis. A 78-year-old woman presented with right upper abdominal tenderness and positive Murphy's sign during chemotherapy for advanced multiple metastases of the breast cancer. Abdominal ultrasonography and computed tomography showed a slightly thickened gallbladder wall and two calculi. After a diagnosis of acute calculous cholecystitis was established, LC was performed. Pathological examination revealed poorly differentiated adenocarcinoma infiltrating the submucosal and subserosal layer over the entire gallbladder, and a lymph node metastasis in the gallbladder neck. Immunohistochemical examination revealed that the tumor cells tested positive for estrogen receptor and negative for progesterone receptor, which was consistent with primary breast cancer. The patient was uneventfully discharged without abdominal pain 7 days later. Although she subsequently underwent several chemotherapies, she died 16 months later. In conclusion, gallbladder metastasis should be considered in patients with multiple metastatic breast cancer who present with signs or symptoms of cholecystitis. Moreover, LC should be considered to relieve the symptoms of cholecystitis for improved prognosis, even in a patient with multiple metastases.
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Affiliation(s)
- Takeshi Urade
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan.
| | - Shigeteru Oka
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Shinya Iimori
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Mariko Man-I
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Tomoki Abe
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Hidehiro Sawa
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Yoshiteru Iwatani
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
| | - Yukiko Morinaga
- Department of Diagnostic Pathology, Kita-Harima Medical Center, Ono, Japan
| | - Daisuke Kuroda
- Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan
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