Synchronous gallbladder metastasis originating from residual gastric cancer: a case report and the review of literature

Abstract

Background Gastric cancer rarely metastasizes to the gallbladder. Furthermore, there has never been a case report of simultaneous gallbladder metastasis from residual gastric cancer. Here, we report a case of synchronous gallbladder metastasis originating from a residual gastric cancer. Case presentation A 67-year-old man underwent a follow-up upper endoscopy 18 months after a partial gastrectomy for gastric cancer; an ulcerative lesion was found in the remnant stomach at the gastrojejunal anastomosis. A biopsy revealed gastric signet-ring cell carcinoma (SRCC). A full-body examination revealed no abnormalities other than gallstones in the gallbladder. With a diagnosis of residual gastric cancer (cT2N0M0 cStage I), the patient underwent open total gastrectomy and cholecystectomy. Macroscopic findings of the resected specimen revealed thickening of the gallbladder wall; however, no obvious neoplastic lesions were found on the mucosal surface of the gallbladder. The pathological findings showed that the SRCC had invaded the submucosa of the gastrojejunostomy site with a high degree of lymphatic invasion and lymph node metastases. SRCCs were also found in the lymphatic vessels of the gallbladder wall. These findings suggested the possibility of gallbladder metastasis through lymphatic vessels. The patient and his family members refused postoperative chemotherapy. Ten months after the operation, the patient experienced respiratory failure due to lymphangitis carcinomatosa and died. Conclusions At present, it is difficult to determine whether resection of the gallbladder contributes to an improved prognosis of gastric cancer patients. However, reports in such cases demonstrate that gallbladder metastasis could be a poor predictor of prognosis for gastric cancer.

Exploring Outcomes of Remnant Gastric Cancer: Literature Review

“…However, the lymphatic outflow is different post-gastrojejunostomy because it can also penetrate through the anastomosis site and reach the mesentery of the jejunum. Therefore, cancer metastasis of the remnant stomach can go into the lymphatic system surrounding the original residual arteries when the right gastric, right gastroepiploic, and left gastric vessels are kept following the prior operation (properly post-surgery of benign condition) (13). Because of this, all D2 lymphadenectomy for gastric cancer has to be excised even if there is no clear D2 lymphadenectomy for remnant stomach cancer (fig.…”