Raritní případ uroteliálního karcinomu metastazujícího do stěny žlučníku s projevy akutní cholecystitidy

Czech version

Authors: A. Berková ¹; Z. Chovanec ¹; I. Krejčová ¹; J. Katolická ²; Z. Bednařík ³; V. Červeňák ⁴; P. Vlček ¹; I. Penka ¹
Authors‘ workplace: I. chirurgická klinika LF MU a FN u sv. Anny v Brně ¹; Onkologicko-chirurgické oddělení, LF MU a FN u sv. Anny v Brně ²; I. ústav patologie, LF MU a FN u sv. Anny v Brně ³; Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně ⁴
Published in: Klin Onkol 2023; 36(5): 401-404
Category: Case Report
doi: https://doi.org/10.48095/ccko2023401

Overview

Background: Metastasis to the gallbladder is very rare. This case report highlights a rare cause of acute cholecystitis, which should be considered by the surgeon and other treating physicians in the differential diagnosis of patients with urothelial carcinoma.

Case: We report the case of a 73 year-old man with follow-up oncology care. He was diagnosed with infiltrating urothelial carcinoma in 2019, received neoadjuvant chemotherapy, and subsequently underwent radical cystectomy with ureteroileostomy in April 2020. Histology confirmed complete regression of bladder cancer, the lymphonodes were also free of tumour infiltration. In July 2021, the patient was examined for intermittent abdominal pain, predominantly of the right upper quadrant. On clinical examination, the gallbladder hydrops was palpable and a positive Murphy‘s sign was present. Due to the signs of acute cholecystitis, the patient was indicated for acute cholecystectomy. Gallbladder histology revealed metastatic involvement of the gallbladder wall by urothelial carcinoma.

Conclusion: If patients with bladder cancer present with intermittent right subcostal pain or signs of acute cholecystitis and diagnostic imaging shows a thickened gallbladder wall, clinicians and radiologists should consider the possibility of metastatic origin of lesion.

Keywords:

urothelial carcinoma – metastasis – acute cholecystitis – cholecystectomy

Sources

1. Flaig TW, Spiess PE, Agarwal N et al. Bladder Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18 (3): 329–354. doi: 10.6004/jnccn.2020.0011.

2. Ling XY, Kevric J, DuGuesclin A, et al. Metastatic urothelial carcinoma presenting as acute cholecystitis. Urol Ann 2019; 11 (3): 331–333. doi: 10.4103/UA.UA_144_18.

3. Yoon WJ, Yoon YB, Kim YJ, et al. Metastasis to the gallbladder: a single-center experience of 20 cases in South Korea. World J Gastroenterol 2009; 15 (38): 4806–4809. doi: 10.3748/wjg.15.4806.

4. Shah RJ, Koehler A, Long JD. Bile peritonitis secondary to breast cancer metastatic to the gallbladder. Am J Gastroenterol. 2000; 95 (5): 1379–1381. doi: 10.1111/j.1572-0241.2000.02054.x.

5. Mouchli M, Grider DJ, Yeaton P. Gallbladder metastases: a report of two cases. Case Rep Oncol 2019; 12 (1): 235–240. doi: 10.1159/000497818.

6. Ogu US, Caganap S, Badr AS, et al. Metastatic transitional cell cancer of the gall bladder presenting as acute cholecystitis: a rare phenomenon. OA Surg 2013; 1: 4.

7. Hong SP, Park SW, Lee SJ, et al. Bile duct wall metastasis from micropapillary variant transitional cell carcinoma of the urinary bladder mimicking primary hilar cholangiocarcinoma. Gastrointest Endosc 2002; 56 (5): 756–760. doi: 10.1067/mge.2002.129083.

8. Choi WS, Kim SH, Lee ES, et al. CT findings of gallbladder metastases: emphasis on differences according to primary tumors. Korean J Radiol 2014; 15 (3): 334–345. doi: 10.3348/kjr.2014.15.3.334.