RESUMEN
In the clinical course of malignant melanoma, which can metastasize to multiple organs, gallbladder metastases are rarely detected. A 69-year-old man who underwent resection of a primary malignant melanoma was subsequently treated with nivolumab for lung metastases and achieved complete response. Seven years after surgery, multiple nodules were found in the gallbladder, and he underwent laparoscopic cholecystectomy. The postoperative diagnosis was metastases of malignant melanoma. He has been recurrence-free 8 months after surgery. If radical resection is possible, such surgery should be performed for gallbladder metastases found in patients with other controlled lesions of malignant melanoma.
Asunto(s)
Neoplasias de la Vesícula Biliar , Melanoma , Humanos , Neoplasias de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/secundario , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/tratamiento farmacológico , Masculino , Melanoma/secundario , Melanoma/patología , Melanoma/tratamiento farmacológico , Anciano , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/secundario , Colecistectomía Laparoscópica , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Nivolumab/uso terapéuticoRESUMEN
INTRODUCTION: Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%. PATIENT CONCERNS: We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior. DIAGNOSIS: Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy. INTERVENTION: Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed. OUTCOME: Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy. CONCLUSION: Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.
Asunto(s)
Adenocarcinoma , Colecistectomía Laparoscópica , Neoplasias de la Vesícula Biliar , Humanos , Neoplasias de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/secundario , Neoplasias de la Vesícula Biliar/cirugía , Colecistectomía Laparoscópica/efectos adversos , Masculino , Persona de Mediana Edad , Adenocarcinoma/secundario , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Siembra Neoplásica , Pared Abdominal/patología , Hallazgos IncidentalesAsunto(s)
Colecistitis/diagnóstico por imagen , Errores Diagnósticos , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Cutáneas , Xantomatosis/diagnóstico por imagen , Adulto , Colecistectomía , Colecistitis/patología , Femenino , Neoplasias de la Vesícula Biliar/secundario , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática/patología , Melanoma/secundario , Ganglio Linfático Centinela/cirugía , Xantomatosis/patologíaRESUMEN
RATIONALE: Gallbladder polyps are common in the general population, but gallbladder metastasis of renal cell carcinoma (RCC) is very rare. In a patient with RCC diagnosed with a small gallbladder polyp that does not meet the traditional size criteria, the surgeon faces a dilemma of whether cholecystectomy should be performed given the possibility of metastasis. PATIENT CONCERNS: A 55-year-old man who had received a left nephrectomy for RCC presented with a gallbladder polyp that was noted at the time of the nephrectomy. Imaging showed the maximum diameter of the polyp had increased from 5âmm to 24âmm in the 40 months after the initial diagnosis. DIAGNOSIS: Pathological and immunohistology findings confirmed the gallbladder polyp as a metastasis of clear-cell RCC. INTERVENTIONS: : We performed a laparoscopic cholecystectomy. OUTCOMES: Even though the synchronous solitary gallbladder metastasis was left untreated and a cholecystectomy was not performed over the 40 months, no metastasis occurred in other sites. The patient is free from disease 10 months after the cholecystectomy. LESSONS: Solitary gallbladder metastasis of RCC may have more favorable outcomes than typical metastases. Although gallbladder metastasis of RCC occur rarely, it can occur, and any changes in gallbladder polyps in RCC patients should be managed under a strong suspicion of metastasis.
Asunto(s)
Carcinoma de Células Renales/secundario , Enfermedades de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/secundario , Neoplasias Renales/patología , Pólipos/patología , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/cirugía , Colecistectomía/métodos , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Enfermedades de la Vesícula Biliar/etiología , Enfermedades de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/complicaciones , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/cirugía , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Pólipos/etiología , Pólipos/cirugíaRESUMEN
Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. A third of people with RCC have metastatic lesions when diagnosed, and another third develop metachronous metastasis during follow-up or after surgical treatment. We report a case of gallbladder metastasis from clear-cell RCC in a 71-year-old woman 13 years after RCC of her right kidney. Preoperative imaging studies showed a suspicious, progressively enlarged gallbladder polyp. The patient underwent open cholecystectomy and lymph node dissection along the hepatoduodenal ligament. The pathology report was compatible with metastatic disease from the kidney that was previously resected. Gallbladder metastasis can occur from RCC several years after initial management. Physicians should be aware of this rare pathology, and intensive follow-up is essential after surgery for RCC.
Asunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias Renales/patología , Recurrencia Local de Neoplasia/diagnóstico , Pólipos/diagnóstico , Anciano , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Pancreatocolangiografía por Resonancia Magnética , Colecistectomía , Diagnóstico Diferencial , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/secundario , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Recurrencia Local de Neoplasia/secundario , Recurrencia Local de Neoplasia/cirugía , NefrectomíaRESUMEN
Cholecystitis is one of the leading causes of emergency surgical interventions; the occurrence of metastases to the gallbladder is rare and has only been reported in the literature exceptionally. Metastatic breast cancer to the gallbladder is even less frequent; in fact, breast cancer usually metastasizes to bone, lung, lymph nodes, liver and brain. We report the case of an 83-year-old female patient with a previous history of breast surgery with axillary dissection in 1997, followed by adjuvant chemotherapy due to invasive ductal carcinoma of the left breast. The patient was admitted at the emergency department for sepsis and an episode of acute kidney failure, anuria and fever. Right-upper quadrant abdominal pain triggered by food intake and abdominal tenderness was also present, placing the diagnostic suspicion of biliary sepsis due to acute cholecystitis. The histological examination of the surgical specimen highlighted the presence of metastasis from an infiltrating ductal breast carcinoma with positive hormone receptors. We also report here the results of a review of the literature looking at articles describing cases of gallbladder metastasis from breast cancer.
Asunto(s)
Neoplasias de la Mama/patología , Colecistitis Aguda , Neoplasias de la Vesícula Biliar , Anciano de 80 o más Años , Neoplasias de la Mama/terapia , Colecistitis Aguda/etiología , Colecistitis Aguda/cirugía , Femenino , Neoplasias de la Vesícula Biliar/secundario , Neoplasias de la Vesícula Biliar/cirugía , HumanosRESUMEN
Gallbladder metastasis from gastric cancer is often found accidentally during postoperative pathological examinations, and its preoperative diagnosis is very difficult. There are a few reports in diagnostic imaging, and it is well known to have a very poor prognosis. There have been 13 reports on gallbladder metastasis from gastric cancer in the Japanese literature. Among the 13 reports, 10 cases were diagnosed with gallbladder metastasis synchronously and only 1 case was diagnosed as gallbladder metastasis before surgery. One case was reported as hematogenous metastasis, and 9 cases were reported as lymphoid metastasis. In total, 7 patients died, all within the first year after surgery. We experienced a case of synchronous gallbladder metastasis from gastric cancer.
Asunto(s)
Neoplasias de la Vesícula Biliar , Neoplasias Gástricas , Neoplasias de la Vesícula Biliar/secundario , Humanos , PronósticoAsunto(s)
Carcinoma Adenoescamoso/secundario , Neoplasias de la Vesícula Biliar/secundario , Vesícula Biliar/patología , Neoplasias Hepáticas/patología , Hígado/patología , Anciano , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Carcinoma Adenoescamoso/genética , Carcinoma Adenoescamoso/metabolismo , Carcinoma Adenoescamoso/cirugía , Vesícula Biliar/metabolismo , Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/genética , Neoplasias de la Vesícula Biliar/metabolismo , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Inmunohistoquímica , Queratina-19/genética , Queratina-19/metabolismo , Queratina-7/genética , Queratina-7/metabolismo , Hígado/metabolismo , Hígado/cirugía , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/cirugía , Masculino , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias de la Vesícula Biliar/secundario , Melanoma/patología , Neoplasias Cutáneas/patología , Colecistectomía , Femenino , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Imagen por Resonancia Magnética , Melanoma/terapia , Persona de Mediana Edad , Metástasis de la Neoplasia , Tomografía de Emisión de Positrones , Neoplasias Cutáneas/terapiaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/secundario , Melanoma/diagnóstico por imagen , Melanoma/patología , Neoplasias de la Vesícula Biliar/terapia , Antineoplásicos Inmunológicos/administración & dosificación , Colecistectomía Laparoscópica , Estudios de Seguimiento , Nivolumab/administración & dosificaciónRESUMEN
A hepatic cholangiocarcinoma with metastases in the gallbladder, left elbow joint, adrenal glands, and lungs was observed in a female 21-yr-old free-ranging Eurasian brown bear (Ursus arctos arctos) found in the Principality of Asturias (northern Spain). Gross and histopathologic findings are described.
Asunto(s)
Neoplasias de los Conductos Biliares/veterinaria , Colangiocarcinoma/veterinaria , Ursidae , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/veterinaria , Animales , Animales Salvajes , Neoplasias de los Conductos Biliares/patología , Neoplasias Óseas/patología , Neoplasias Óseas/secundario , Neoplasias Óseas/veterinaria , Colangiocarcinoma/patología , Miembro Anterior/patología , Neoplasias de la Vesícula Biliar/secundario , Neoplasias de la Vesícula Biliar/veterinaria , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/veterinaria , EspañaAsunto(s)
Carcinoma de Células Renales/patología , Neoplasias de la Vesícula Biliar/secundario , Cálculos Biliares/diagnóstico , Neoplasias Renales/patología , Adulto , Cuidados Posteriores , Carcinoma de Células Renales/complicaciones , Colecistectomía Laparoscópica/métodos , Colecistitis/etiología , Enfermedad Crónica , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Masculino , Metástasis de la Neoplasia , Neoplasias Primarias Secundarias/patología , Resultado del Tratamiento , UltrasonografíaAsunto(s)
Carcinoma de Células Renales/secundario , Neoplasias de la Vesícula Biliar/secundario , Neoplasias Renales/patología , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/cirugía , Colecistectomía , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Neoplasias Renales/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
AIMS: Outcomes of colorectal cancer (CRC) treatment and survival have steadily improved during the past decades, accompanied by an increased risk of developing second primary tumours and metastatic tumours at unusual sites. Metastatic CRC can show mucosal colonisation, thereby mimicking a second primary tumour. This potential confusion could lead to incorrect diagnosis and consequently inadequate treatment of the patient. The aim of this study was to differentiate between metastatic CRC and a second primary (gallbladder cancer, GBC) using a combination of standard histopathology and molecular techniques. METHODS AND RESULTS: Ten consecutive patients with both CRC and GBC were identified in our region using the Dutch National Pathology Archive (PALGA). Two patients served as negative controls. Histology of GBC was reviewed by nine pathologists. A combination of immunohistochemistry, microsatellite analysis, genomewide DNA copy number analysis and targeted somatic mutation analysis was used to aid in differential diagnosis. In two patients, CRC and GBC were clonally related, as confirmed by somatic mutation analysis. For one case, this was confirmed by genomewide DNA copy number analysis. However, in both cases, pathologists initially considered the GBC as a second primary tumour. CONCLUSIONS: Metastatic CRC displaying mucosal colonisation is often misinterpreted as a second primary tumour. A combination of traditional histopathology and molecular techniques improves this interpretation, and lowers the risk of inadequate treatment.
Asunto(s)
Adenocarcinoma/secundario , Biomarcadores de Tumor/análisis , Neoplasias Colorrectales/patología , Neoplasias de la Vesícula Biliar/secundario , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/genética , Análisis Mutacional de ADN , Diagnóstico Diferencial , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/genética , Humanos , Masculino , Persona de Mediana EdadRESUMEN
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.
Asunto(s)
Colecistectomía , Neoplasias de la Vesícula Biliar/diagnóstico , Vesícula Biliar/cirugía , Hallazgos Incidentales , Linfoma/diagnóstico , Adulto , Anciano , Femenino , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/secundario , Humanos , Estimación de Kaplan-Meier , Linfoma/mortalidad , Linfoma/patología , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , SueciaRESUMEN
Malignant conjunctival melanoma is a rare tumor. A 46-year-old woman with a history of locally recurrent left conjunctival melanoma was followed by F-FDG PET/CT. Four years after the local recurrence treated by orbital exenteration, the follow-up PET/CT scan showed an incidental intense FDG uptake mass infiltrating the gallbladder associated with a low uptake of an infracentimetric pulmonary nodule. The patient was completely asymptomatic with no sign of local recurrence. Laparoscopic cholecystectomy was performed, and histopathologic findings were consistent with gallbladder metastasis of melanoma. After almost 2 years of immunotherapy, the patient is still in complete response.