Two cases of gallbladder metastasis from renal cell carcinoma and review of literature

Abstract

BackgroundRenal cell carcinoma accounts for 90 % of renal neoplasms and metastatic disease is common. One third of newly diagnosed cases will have synchronous metastases at diagnosis and further 25–50 % will develop metachronous disease. Case PresentationThis study presents two new cases of gallbladder metastasis from renal cell carcinoma (RCC) from our institution and reviews the published literature. The final cohort included 52 evaluable patients. M/F ratio was 2:1 and median age was 62.5 years. Most patients were diagnosed incidentally after follow-up or staging imaging for RCC. Of the patients with available histology, all except one were clear cell type (n = 39) and 92 % were polypoid. Thirty-six patients demonstrated metachronous gallbladder metastasis with median disease-free interval (DFI) from nephrectomy of 4 years. The most frequent site of metastasis was the contralateral kidney (46.7 %) followed by the pancreas and lung. The median disease-free interval (DFS) after cholecystectomy was 37 months. Three- and five-year OS rates were 74 and 62 %, respectively. Age younger than 45 years (p = 0.008) and DFI <24 months (p = 0.049) were associated with decreased OS.ConclusionsRCC metastasis to the gallbladder is associated with an unusual pattern of concomitant metastasis. Symptoms are not common. Simple cholecystectomy is associated with increased OS and nil local or port site recurrence. Young age and short DFI are associated with decreased OS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-0843-3) contains supplementary material, which is available to authorized users.

Cystic Duct Metastasis from Renal Cell Carcinoma

“…Therefore, metastatic tumors of the gallbladder show polypoid lesions. In the present case, the cystic duct tumor was also present in the lamina propria and showed polypoid growth, as reported previously ( 3 , 10 ). RCC has a high potential for hematogenous metastasis, and the most common metastatic sites are vascular-rich organs.…”

“…In addition, up to 50% develop metastatic disease metachronously after surgical resection. The most common sites of distant metastasis are the lung, bone, liver, adrenal gland, brain, and contralateral kidney ( 2 , 3 ). RCC metastasis to the gallbladder is rare and has only been found in 0.58% of cases at necropsy ( 7 ).…”

“…RCC metastasis to the gallbladder is rare and has only been found in 0.58% of cases at necropsy ( 7 ). Neves et al reported a review of 52 patients published in the English and Japanese literature ( 3 ). Metachronous gallbladder metastasis was found in 69.2% of patients with a median disease-free interval from nephrectomy of 4 years.…”

“…Cancer metastasis is considered to result from hematogenous, lymphatic, disseminated, and direct invasion. Cancer often metastasizes hematogenously to the lamina propria of the gallbladder wall ( 10 ), and gallbladder metastasis shows characteristic polypoid lesions ( 3 ). We consider that cancer that has metastasized to the lamina propria of the gallbladder wall can spread easily to the mucosal side because the muscularis propria is located under the lamina propria.…”

Colorectal metastasis to the gallbladder mimicking a primary gallbladder malignancy: histopathological and molecular characteristics

“…CRC metastasising to the gallbladder seems almost non‐existent, with only a few case reports in the English literature . Metastases of other primary cancer types to the gallbladder, such as melanoma or renal cell carcinoma, are more frequently observed, presumably because of their distinct histological features …”