Imaging of gallbladder metastasis

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.

Keywords: Gallbladder; Magnetic resonance imaging; Neoplasm metastasis; Tomography (X-ray computed); Ultrasound imaging.

Fig. 1

A 56-year-old male hospitalized for right upper abdominal pain with nausea and vomiting. The pain was irradiated to the right scapular region. His medical history included a total excision of dorsal melanoma 2 years before, with no evidence of metastatic disease at the primary staging. The B-mode US (a) showed the gallbladder lumen completely filled with heterogeneous content which was difficult to differentiate between tumefactive biliary sludge and parietal mass. The corresponding color-doppler (b) revealed no vascular signal within the endoluminal content. CEUS (c) demonstrated the vascularization of 2 polypoid lesions (arrows) protruding into the gallbladder lumen with intense contrast enhancement in the arterial phase (20 s). The portal venous phase CT images (d, e) confirmed two enhancing mural nodules (arrows) of galbladder wall that were histologically proved to be metastases from melanoma

Fig. 2

Axial (a, b) and coronal (c) T2-weighted MRI images of an asymptomatic 59-year-old female underwent surgery for a right scapular melanoma 4 years before, with no evidence of metastatic disease at the primary staging. MRI was recommended after a US examination reporting a nonspecific gallbladder mass. The patient was in good general health, nutritional and hydration status. No palpable masses were observed at the clinical examination. MRI images showed a vegetant endoluminal hypointense mass with broad mural base and focal wall thickening. A cholecystectomy was performed and a metastasis from melanoma was histologically confirmed