Successful multimodality treatment of metastatic gallbladder cancer: A case report and review of literature

Abstract

Background: Gallbladder cancer is the most common malignant tumor in the biliary system, and it is characterized by high aggressiveness and an extremely poor prognosis. Current treatment for advanced gallbladder cancer remains unsatisfactory. Here, we report a patient with advanced gallbladder cancer who was cured by multidisciplinary treatment.

Case summary: A 73-year-old male presented to our hospital with right abdominal pain for 3 d and was diagnosed with stage IVB gallbladder cancer with multiple liver metastases, peritoneum metastasis, diaphragm metastasis and lymph node metastases. The patient initially received chemotherapy, targeted therapy, ¹²⁵I seed implantation and immunotherapy, as there were no specific indications for radical surgery. During these palliative therapies, the level of tumor markers gradually decreased but remained higher than the normal level, lymph node metastases gradually disappeared, and liver metastasis was gradually limited to the left liver. Finally, the patient received radical surgery with left hepatectomy, radical lymphadenectomy and partial diaphragmatic resection. To date, the patient has survived for more than six years posttreatment, the levels of tumor markers are normal, and imaging examinations show no signs of tumor recurrence.

Conclusion: Currently, the prognosis of advanced gallbladder cancer remains unsatisfactory. A single treatment method is not sufficient for patients with advanced gallbladder cancer. Multidisciplinary individualized treatment is essential and should be utilized for advanced gallbladder cancer patients to further improve prognosis.

Keywords: Advanced gallbladder cancer; Case report; Long-term survival; Multidisciplinary treatment.

Figure 1

Abdominal magnetic resonance imaging in December 2014. Abdominal magnetic resonance imaging showed the tumor infiltrated the whole stratum of the gallbladder wall (blue arrow) and metastasized to the left and right liver (red arrow).

Figure 2

¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in December 2014. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography depicted gallbladder cancer with multiple liver metastases, peritoneum metastasis, diaphragm metastasis and lymph node metastases.

Figure 3

Pathology of fine needle aspiration of the liver metastases in December 2014. Pathological result indicated that adenocarcinoma, and the tumor cells showed a tubular and nested infiltrating growth (red arrow).

Figure 4

The tumor markers levels during chemotherapy and targeted therapy. The levels of carcinoembryonic antigen, carbohydrate antigen19-9 (CA19-9) and CA12-5 gradually decreased but remained higher than the normal levels during chemotherapy and targeted therapy. CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen19-9; CA12-5: Carbohydrate antigen12-5.

Figure 5

Abdominal magnetic resonance imaging in August 2015. Abdominal magnetic resonance imaging showed that the gallbladder was malformed and that the right liver metastasis was larger than the prior scan (red arrow).

Figure 6

¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in March 2016. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography showed that ¹²⁵I seeds were around the gallbladder, but the gallbladder was not clearly visible (blue arrow). The left and right liver metastases still existed (red arrow).

Figure 7

Abdominal computed tomography and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in February 2018. A-C: Abdominal computed tomography showed that the gallbladder had disappeared and that the liver metastasis was limited to the left liver (red arrow); D: ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography showed that the liver metastasis was limited to the left liver (red arrow).

Figure 8

Surgical specimen, hematoxylin-eosin staining and immunohistochemical examination. A: Surgical specimen; B: Hematoxylin-eosin staining showed tumor cells grew in infiltrating glandular ducts and nests (× 200); C: Immunohistochemical examination indicated ARGINASE-1 (-) (× 200); D: Immunohistochemical examination indicated CK19 (+) (× 200); E: Immunohistochemical examination indicated GPC-3 (partial +) (× 200); F: Immunohistochemical examination indicated hep-par (-) (× 200); G: Immunohistochemical examination indicated CEA (partial+) (× 200); H: Immunohistochemical examination indicated CK20 (-) (× 200); I: Immunohistochemical examination indicated CK7 (+) (× 200).

Figure 9

Abdominal computed tomography of follow-up. A: Abdominal computed tomography (CT) in October 2019 showed postoperative changes and no signs of tumor recurrence; B: Abdominal CT in March 2021 showed postoperative changes and no signs of tumor recurrence.