Metastatic breast carcinoma initially presenting as acute cholecystitis: a case report and review of the literature

Introduction: The gallbladder is an infrequent site of metastatic malignant disease. Although malignant melanoma, renal cell and cervical carcinoma have been documented, breast carcinoma has rarely been reported to metastasize in the gallbladder. Case Report: We describe such a case that manifested as acute cholecystitis and was incidentally recognized after cholecystectomy, in an otherwise disease-free 46-year-old female who had undergone mastectomy for breast cancer two years before. The patient was subjected to adjuvant chemotherapy, but unfortunately died just a year after diagnosis because of generalized peritoneal seeding of the tumor. Discussion: Metastatic gallbladder involvement is rare, especially in cases of primary breast carcinoma, usually leading to symptoms of abdominal pain, mimicking acute or chronic cholecystitis. Thus, abdominal pain in a patient with a previous history of breast carcinoma should raise suspicion of gallbladder metastasis.

Metastatic breast cancer; Acute cholecystitis; Ductal breast carcinoma; Gallbladder metastasis

[1] Beaver B.L., Denning D.A., Minton J.P.: “Metastatic breast carcinoma of the gallbladder”. J. Surg. Oncol., 1986, 31, 240.

[2] Langley R.G.B., Bailey E.M., Sober A.J.: “Acute cholecystitis from metastatic melanoma to the gallbladder in a patient with a low-risk melanoma”. Br. J. Dermatol., 1997, 136, 279.

[3] Chan K.W.: “Review of 253 cases of significant pathology to 7,910 cholecystectomies in Hong Kong”. Pathology, 1988, 20, 20.

[4] Crawford D.L., Yeh I.T., Moore J.T.: “Metastatic breast carcinoma presenting as cholecystitis”. Am. Surg., 1996, 62, 745.

[5] Shah R.J., Koehler A., Long J.D.: “Bile peritonitis secondary to breast cancer metastatic to the gallbladder”. Am. J. Gastroenterol., 2000, 95, 1379.

[6]Lam C.M., Yuen A.W., Wai A.C., Leung R.M., Lee A.Y., Ng K.K., Fan S.T.: “Gallbladder cancer presenting with acute cholecystitis”. Surg. Endosc., 2005, 19, 697.

[7] Abrams H.L., Spiro R., Goldstein N.: “Metastases in carcinoma, analysis of 1000 autopsied cases”. Cancer, 1950, 3, 74.

[8] Lee Y.N.: “Breast carcinoma: Pattern of metastasis at autopsy”. J. Surg. Oncol., 1987, 5, 969.

[9] Rubin A., Tate J.J.: “Breast carcinoma metastatic to the gallbladder”. J. Clin. Pathol., 1987, 46, 1223.

[10] Yeu-Tsu M.L.N.: “Breast carcinoma: pattern of metastasis at autopsy”. J. Surg. Oncol., 1983, 23, 175.

[11] Bush E., Geradts J., O’Connor T.: “An unusual cause of cholecystitis?”. Am. J. Clin. Oncol., 2005, 28, 529.

[12] Pappo I., Feigin E., Uziely B., Amir G.: “Biliary and pancreatic metastases of breast carcinoma: Is surgical palliation indicated?”. J. Surg. Oncol., 1991, 46, 211.

[13]Lokich J.J., Kane R.A., Harrison D.A., McDermott W.V.: “Biliary tract obstruction secondary to cancer: Management guidelines and selected literature review”. J. Clin. Oncol., 1987, 5, 969.

[14] Popp J.W., Schapiro R.H., Warshaw A.L.: “Extrahepatic biliary obstruction caused by metastatic breast carcinoma”. Ann. Intern. Med., 1979, 91, 568.

[15] Rabin M.S., Richter I.A.: “Metastatic breast carcinoma presenting as obstructive jaundice. A report of three cases”. S. Afr. Med. J., 1979, 55, 388.

[16] Franco D., Martin B., Smadja C.: “Biliary metastases of breast carcinoma: the case of resection”. Cancer, 1987, 60, 96.

[17] Kopelson G., Chu A.M., Doucette J.A., Gunderson L.L.: “Extrahepatic biliary tract metastases from breast cancer”. Int. J. Radiat. Oncol. Biol. Phys., 1980, 6, 497.

[18] Howel A., Harris M.: “Infiltrating lobular carcinoma of the breast”. Br. J. Med., 1985, 291, 1371.

[19] Kaufman O., Deidesheimer T., Muehlenberg M.: “Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites”. Histopathology, 1996, 29, 233.

[20] Lee A.K., DeLellis R.A., Rosen P.P.: “Alphalactalbumin as an immuno-histochemical marker for metastatic breast carcinomas”. Am. J. Surg. Pathol., 1984, 8, 93.

[21] Boari B., Pansini G., Pedriali M., Cavazzini L., Manfredini R.: “Acute cholecystitis as a presentation of metastatic breast carcinoma of the gallbladder: a case report”. JAGS, 2005, 53, 2041.

[22] Jemal A., Murray T., Samuels A.: “Cancer statistics”. Cancer J. Clin., 2003, 53, 5.

[23] Murguia E., Quiroga D., Canteros G., San Martino C., Barreiro M., Herrera J.: “Gallbladder metastases from ductal papillary carcinoma of the breast”. J. Hepatobiliary Pancreat. Surg., 2006, 13, 591.

[24] Engel J.J., Trujillo Y., Spelberg M.: “Metastatic carcinoma of the breast: A cause of obstructive jaundice”. Gastroent., 1980, 78, 132.

[25] Toikkanen S., Pylkkanen L., Joensuu H.: “Invasive lobular carcinoma of the breast has better short- and long-term survival than invasive ductal carcinoma”. Br. J. Cancer, 1997, 76, 1234.

[26] Doval C.D., Bhatia K., Pavithran K., Sharma J.B., Vaid A.K., Hazarika D.: “Breast carcinoma with metastasis to the gallbladder: an unusual case report with a short review of the literature”. Hepatobiliary Pancreat Dis. Int., 2006, 5, 305.