Ovarian metastases from gallbladder mimics primary ovarian neoplasm in young patient: a case report

Abstract

BackgroundGallbladder cancer is unusually seen but can result in highly mortality rate. It makes challenge to diagnose for clinicians due to present asymptomatic or non-specific clinical presentation including abdominal pain, anorexia. It usually also accompanies with cholelithiasis (incidence is 1–2%) and incidentally detected by radiologic examination such as ultrasound, computed tomography or intra-operative intervention accidentally. Gallbladder cancer results in highly fatal malignancy because it is difficult to early detect. The ovarian metastases from gallbladder mimics primary neoplasm isn’t seen before and mentioned in English literatures before.Case presentationA 28-year-old woman suffered from intermittently lower abdominal tenderness and nausea after meals for 3 years. The abdominal ultrasound revealed a right ovarian mass with fluid accumulation and the contrast CT of abdomen revealed a gallbladder fundus mass and liver tumor lesion located at segment 4. We arranged surgical intervention with radical cholecystectomy and debulking operation with salpingo-oophorectomy. The pathologic report revealed adenocarcinoma of gallbladder with liver, peritoneum, and right ovarian invasion. After surgical intervention, she also received adjuvant chemotherapy with Gemcitabine, Cetuximab, Cisplatin and Cyberknife.ConclusionThe non-specific symptoms make the challenge to difference the primary malignant neoplasm. The rarely diagnosis must take in consider if the gastrointestinal tract tumours coexist with ovarian tumours.

Metastatic Gallbladder Carcinoma to the Ovary Presenting As Small Bowel Obstruction

“…Interestingly, the laterality of the involved ovary is not related to that of the primary tumor [ 6 ]. Most metastatic ovarian neoplasms tend to be bilateral, in contrast to unilateral primary ovarian neoplasms [ 7 ].…”

Bilateral benign cystic teratoma of ovary concomitant with an occult gall bladder carcinoma in a post-menopausal woman

“…Most gallbladder cancers are adenocarcinoma (incidence 70-90%). 2 Gall bladder carcinoma is the fifth most common neoplasm of the digestive tract with an overall incidence of 3 per 10000 people. Gall bladder carcinoma is the most common cancer of the biliary tract, yet only one third of gall bladder carcinomas are recognized preoperatively.…”

“…It may accompany cholelithiasis (incidence 1-2%) and incidentally detected by radiologic examination. 2 It is unusual to encounter bilateral cystic teratoma with gall bladder carcinoma. We report a case of bilateral dermoid cyst with cholelithiasis and occult gall bladder carcinoma in a postmenopausal woman.…”

A rare case of Krukenberg tumor by gallbladder cancer

“…In a retrospective study over 147 patients, Li W et al [14] reported a rate of ovarian metastases of 48.9% by colorectal cancer, 40.8% by gastric cancer, 8.2 by breast cancer and only 1.4% by biliary origin. Unfortunately, there are very few reports that describe cases of metastatic lesions that present clinically as a primary tumor [7,8,[15], [16], [17]]. The high rate of bilaterality, surface involvement by tumor cells, multinodular growth, extensive extra-ovarian tumor, size >10 cm, infiltrative and nodular pattern of invasion, and presence of signet ring cells are the most helpful features for indicating a metastatic nature of an ovarian mass [7,[18], [19], [20], [21]].…”

“…There are no studies about therapeutic strategies and outcomes in ovarian metastases from biliary origin, because of its rarity and poor prognosis. Many studies have underlined the benefit of aggressive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in Krukenberg tumours form gastric and colo-rectal cancers [16,17,21]. The identification of the primary tumor site is required to plan the best therapeutic option for these patients: sometimes, palliative surgery is required, as in this specific case.…”