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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 35-36

Breast metastasis from carcinoma of gall bladder


1 Department of General Surgery Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
2 Department of CVTS, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
3 Department of Pathology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
4 Department of Radiotherapy, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Date of Web Publication17-Apr-2013

Correspondence Address:
Mohd Lateef Wani
Department of CVTS, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.110558

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  Abstract 

Carcinoma of gall bladder has early lymphatic and haematogenous spread. Most common extra abdominal site of metastasis is the lung. Metastasis to breast from carcinoma of breast is very rare. Our case describes an interesting case of carcinoma of gall bladder metastising to breast. A 50-year-old female presented to our outpatient department with a small nodule on upper outer quadrant of left breast. Patient had a history of cholecystectomy done for symptomatic gall stones 2 years back. Histopathological examination of the gall bladder specimen showed adenocarcinoma of the gall bladder with invasion to lamina propria. No additional treatment was offered to the patient. The breast nodule was excised and sent for histopathological examination. Histopathological examination revealed metastising adenocarcinoma. Patient was subjected to palliative chemotherapy (Gamcitabine and carboplatin). However, patient died of hepatic encephalopathy after 5 months. Our case reports an unusual site of metastasis from carcinoma of gall bladder which is very rare.

Keywords: Adenocarcinoma, breast metastasis, cholecystectomy


How to cite this article:
Malik AA, Wani ML, Wani SN, Malik RA, Malik TR. Breast metastasis from carcinoma of gall bladder. Int J Health Allied Sci 2013;2:35-6

How to cite this URL:
Malik AA, Wani ML, Wani SN, Malik RA, Malik TR. Breast metastasis from carcinoma of gall bladder. Int J Health Allied Sci [serial online] 2013 [cited 2019 Aug 22];2:35-6. Available from: http://www.ijhas.in/text.asp?2013/2/1/35/110558


  Introduction Top


Carcinoma of Gall bladder is one of the most common malignancies in India. The usual mode of dissemination is direct, lymphatic, vascular, and intra-ductal. Carcinoma of gall bladder metastising to breast is very rare, hence reported here. This spread was probably via haematogenous rout.


  Case Report Top


A 50-year-old female patient presented to our outpatient department with a small nodule on upper outer quadrant of left breast [Figure 1]. It was painless and progressively increasing in size. On inquiring, patient had past history of cholecystectomy done 2 years before, for symptomatic gall stones in a private nursing home. Histopathological examination of Gall bladder was showing adenocarcinoma with invasion to lamina propria. Patient had a full metastatic profile done at that time which showed no metastasis. Patient was offered no additional treatment for the same. On physical examination, patient was cachexic and pale. There was no icterus, no lymphadenopathy anywhere. Examination of chest, abdomen, and cardiovascular system revealed nothing abnormal. Local examination of the breast nodule revealed a non-tender, firm nodule of 2 cm × 3 cm in size fixed to skin but not to pectoral fascia. Excision biopsy of this nodule revealed adenocarcinoma [Figure 2]. An ultrasonography of abdomen showed growth at gall bladder bed with infiltration into the liver. Computed tomography scan showed the same findings. Patient was diagnosed to have a metastising adenocarcinoma of gall bladder and was subjected to chemotherapy. Patient received chemotherapy of gamcitabine and carboplatin. After 4 months of treatment, patient developed jaundice and deteriorated rapidly. Finally patient developed hepatic encephalopathy and died of same.
Figure 1: Breast nodule

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Figure 2: Histology of nodule

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  Discussion Top


Incidence of secondary metastating breast disease range from 0.5% to 6.6% in all breast malignancies. [1] The most common primary tumor metastising to breast include lymphoma, melanoma, rabdomyosarcoma, lung tumors, and ovarian malignancies and Carcinoma of gall bladder primarily spread by direct extension. Liver is the most common site of direct extension. Other organs commonly affected are bile duct, duodenum, stomach, colon, omentum, pancreas etc., In about 80-86% of the patients' metastasis to liver is present. 60% of the patients have metastasis to regional lymph nodes. Lung is the most common site of extra abdominal metastasis via haematogenous spread. Rare sites of metastasis include Central Nervous System, [2],[3] skin, [4],[5] bone, [6] scalp, [7] orbit, [8],[9] and heart. [10] Metastasis to breast from a carcinoma of gall bladder can occur via haematogenous rout. To our best knowledge, this is the first reported case of breast metastasis from carcinoma of gallbladder.

 
  References Top

1.Bartella L, Kaye J, Perry NM, Malhotra A, Evans D, Ryan D, et al. Metastases to the breast revisited: Radiological-histopathological correlation. Clin Radiol 2003;58:524-31.  Back to cited text no. 1
    
2.Kawamata T, Kawamura H, Kubo O, Sasahara A, Yamazato M, Hori T. Central nervous system metastasis from gallbladder carcinoma mimicking a meningioma. Case illustration. J Neurosurg 1999;91:1059.  Back to cited text no. 2
    
3.Agrawal A, Agrawal CS, Kumar A, Tiwari A, Lakshmi R, Yadav R. Gall bladder carcinoma: Stroke as first manifestation. Indian J Gastroenterol 2006;25:316.  Back to cited text no. 3
    
4.Bardaji M, Roset F, Puig A, Badal J, Fernandez-Layos MJ. Cutaneous metastatic adenocarcinoma of gallbladder origin: Report of a case and review of the literature. Hepatogastroenterology 1998;45:930-1.  Back to cited text no. 4
    
5.Kaur J, Puri T, Julka PK, Gunabushanam G, Iyer VK, Singh MK, et al. Adenocarcinoma of the gall bladder presenting with a cutaneous metastasis. Indian J Dermatol Venereol Leprol 2006;72:64-6.  Back to cited text no. 5
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6.Singh S, Bhojwani R, Singh S, Bhatnagar A, Saran RK, Agarwal AK. Skeletal metastasis in gall bladder cancer. HPB (Oxford) 2007;9:71-2.  Back to cited text no. 6
    
7.Pandey M, Aryya NC, Pradhan S, Asthana AK, Gautam A, Shukla VK. Carcinoma of the gallbladder presenting as scalp tumour. Eur J Surg Oncol 1998;24:605-7.  Back to cited text no. 7
    
8.Misra A, Misra S, Chaturvedi A, Srivastava PK. Case report. Orbital metastasis from gall bladder carcinoma. Br J Radiol 2002;75:72-3.  Back to cited text no. 8
    
9.Puglisi F, Capuano P, Gentile A, Lobascio P, Russo S, Martines G, et al. Retrobulbar metastasis from gallbladder carcinoma after laparoscopic cholecystectomy. A case report. Tumori 2005;91:428-31.  Back to cited text no. 9
    
10.Suganuma M, Marugami Y, Sakurai Y, Ochiai M, Hasegawa S, Imazu H, et al. Cardiac metastasis from squamous cell carcinoma of gallbladder. J Gastroenterol 1997;32:852-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]


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