Colon metastasis from recurrent gallbladder cancer: a case report

Abstract

Gallbladder cancer (GBC) is associated with a poor prognosis. Colonic metastases representing approximately 1% of total colorectal cancers, are very rarely reported. According to more recent data in the literature, cases of colon metastases from GBC have not been reported. We report the case of a 78-year-old woman who underwent a cholecystectomy in 2017, for a diffuse carcinoma in situ and an infiltrating adenocarcinoma pT2a G2; she completed six months of adjuvant gemcitabine chemotherapy and started a regular follow up in our institution. Three years later she came to our observation after having developed severe anemia and she was diagnosed synchronous liver and colonic metastases from GBC immunohistologically confirmed. The case was collegially evaluated by a multidisciplinary team. In consideration of the progressive deterioration of the clinical conditions, the extension of the primary GBC and the patient's age, it was decided to start in July 2020 a first-line mono-chemotherapy treatment with gemcitabine. This is probably the first reported case of colonic metastasis in a patient with a recurrent GBC with synchronous liver involvement. We conclude that though colon is a rare metastatic site of GBC, one should keep vigilance for colon metastases to prevent and detect their occurrence in symptomatic cases in order to improve the survival.

Keywords: Gallbladder cancer recurrence (GBC recurrence); case report; colon metastasis; palliation.

Figure 1

CTCE axial plane. CT image shows a focal parietal thickening with contrast enhancement at the level of the left colon. Arrow shows the thickening mentioned above.

Figure 2

CTCE axial plane. CT image shows a focal parietal thickening with contrast enhancement at the level of the sigmoid tract. Arrow shows the aforementioned thickening.

Figure 3

Endoscopic finding on colonoscopy: eroded and easily bleeding nodular mucosal area in sigmoid tract with diverticular disease (DICA-3). Arrow shows the nodular area mentioned above.

Figure 4

Hematoxylin eosin stain (20×): neoplastic gland with moderate cytologic atypia and moderately to poor differentiated glandular architecture.

Figure 5

Immunohistochemistry CK7 stain (20×): cK7 expression in neoplastic glands on the left side, negative stain in normal colonic glands on the right side.

Figure 6

Immunohistochemistry CDX2 stain (20×): negative neoplastic glands surrounded by normal colonic glands with CDX2 nuclear expression in the upper side.

Figure 7

Immunohistochemistry cK20 stain (20×): cK20 negative neoplastic glands on the left side and normal colonic glands which retain cK20 expression on the right side.

Figure 8

Patient history. GBC, gallbladder cancer; GEM, gemcitabine; CHT, chemotherapy; CT, computed tomography; mets, metastases; fnab, fine needle ago-biopsy; SD, stable disease; US, ultrasound.