Metastatic gallbladder carcinoma presenting as an ovarian mass

Abstract

Metastatic gallbladder carcinoma to the ovaries is occasional but a recognized entity. It can mimic, clinical and morphologically, a primary ovarian tumor, challenging the diagnosis. We present the case of a patient with a lump in the hypogastrium extending into the right iliac fossa and was found to have abdominopelvic cystic lesion with enhancing solid components and multiple sub-centimetric and ill-defined abdominal lymph nodes. Also, subpleural and parenchymal nodules in the lungs were present. She subsequently underwent a laparotomy. Cholecystectomy was also done due to pre-existing symptomatic biliary lithiasis. The histologic report described the ovarian involvement as metastases from a gallbladder carcinoma. The presentation of ovarian metastases can challenge the diagnosis. Hence, careful evaluation of the digestive tract and judicious use of immunohistochemistry should be considered in patients presenting with ovarian masses.

Metastatic Gallbladder Carcinoma to the Ovary Presenting As Small Bowel Obstruction

“…Imaging characteristics of gallbladder carcinomas with metastasis to the ovary may resemble cholecystitis or cholelithiasis, and reports are rare [ 8 ]. The majority of patients present with non-specific abdominal or pelvic symptoms.…”

“…These glands were positive for CK7, CDX2, and CA 19-9, and negative for CK20, CA 125, and PAX8, favoring a diagnosis of metastatic adenocarcinoma of pancreaticobiliary origin. In contrast, primary ovarian tumors are usually large, multicystic masses with smooth surfaces, seldom infiltrative histology, nuclear expression of PAX8, and dual positivity for CK7 and CK20 [ 8 ].…”

“…Chemotherapy regimens are also different. The five-year survival rate of primary gallbladder cancer is abysmal (5%), whereas that of stage IV ovarian cancer is 19% and stage III ovarian cancer is 40-50% [ 8 ]. The combination of surgery with chemotherapy is associated with a significant improvement in survival in stage IV gallbladder cancer patients compared to patients treated with either surgery or chemotherapy alone [ 9 ].…”