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Upadhyay AK, Shekhar S, Kumar A, Chowdhury S. Gallbladder carcinoma presenting with disseminated bony metastasis. BMJ Case Rep 2024; 17:e257753. [PMID: 38176748 PMCID: PMC10773285 DOI: 10.1136/bcr-2023-257753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Gallbladder cancer (GBC) is the 23rd most common cancer worldwide and one of the three leading cancers in North and Northeast India. GBC has inferior outcomes due to its advanced presentation and poor response to chemotherapy. The approximate 5-year survival rate for metastatic GBC is less than 5%, with a median survival of around 6 months. Distant metastases from GBC to the bones happen in the later part of the natural history of the disease. Presentation with bony metastasis is infrequent, and less than 25 cases have been reported. Our case was an elderly man in his 70s who presented with back pain and, on workup, was detected to have adenocarcinoma of the gall bladder with disseminated lytic bony metastasis without any visceral metastasis. This case describes the natural history of such cases and discusses the role of bone scan or fluorodeoxyglucose positron emission tomography in the workup for GBC.
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Affiliation(s)
| | - Shashank Shekhar
- Medical Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India
| | - Abhishek Kumar
- Nuclear Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
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Paolino G, Pampena R, Grassi S, Mercuri SR, Cardone M, Corsetti P, Moliterni E, Muscianese M, Rossi A, Frascione P, Longo C. Alopecia neoplastica as a sign of visceral malignancies: a systematic review. J Eur Acad Dermatol Venereol 2019; 33:1020-1028. [PMID: 30767283 DOI: 10.1111/jdv.15498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
Alopecia neoplastica (AN) from visceral tumours is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumour. We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered. We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed. In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% vs. 46.3%). The most frequent site of the primary tumour was the gastrointestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of the cases (66.1%), AN lesions were single and were mainly diagnosed after the primary visceral tumour (71.5%). Finally, survival analysis highlighted a lower progression-free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.
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Affiliation(s)
- G Paolino
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - R Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Grassi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - S R Mercuri
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy
| | - M Cardone
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Corsetti
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - E Moliterni
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - M Muscianese
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - A Rossi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Skeletal metastasis in gallbladder cancer from a high-volume tertiary care center of north India: a series of rare occurrence. J Gastrointest Cancer 2015; 46:36-41. [PMID: 25432582 DOI: 10.1007/s12029-014-9666-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Gallbladder carcinoma is usually characterized by late diagnosis and poor prognosis. Skeletal metastases in gallbladder cancer have been rarely reported in literature. In this study, we evaluated the incidence of skeletal metastasis in gallbladder cancer at our high-volume center and their clinical presentation, radiological imaging, treatment received, outcome, and survival. METHODS Records of all gallbladder carcinoma patients registered in our department from October 2007-October 2012 were retrospectively reviewed to identify gallbladder cancer patients with skeletal metastasis and their data was collected and analyzed. RESULTS Out of 340 cases of gallbladder carcinoma, 189 (55.58 %) were having stage IV disease. Of these, seven (2.1 %) patients had cytologically proven skeletal metastasis. All seven patients had advanced loco-regional abdominal disease with coexistent liver metastasis. Presenting symptoms were predominantly weight loss and back pain with markedly elevated serum alkaline phosphatase (median = 1231 IU/ml). Dorsolumbar vertebral metastasis was the most common site of skeletal metastasis in our series (5/7), followed by pelvic bone (2/7) while skull and sternal metastasis were present in one patient each. All these patients had short median survival (median = 30 days, range = 15-60 days). CONCLUSIONS Incidence of skeletal metastasis in gallbladder cancer is very low (2.1 %). Axial skeleton was the most common site of bone metastasis. Gallbladder cancer with skeletal metastasis portends poor prognosis with rapidly fatal course.
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Solitary breast metastasis from recurrent gallbladder carcinoma simulating a second primary on 18F-FDG PET/CT. Clin Nucl Med 2014; 38:e433-4. [PMID: 24096996 DOI: 10.1097/rlu.0b013e31827088c0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gallbladder carcinoma is characterized by poor prognosis. It spreads by direct, lymphatic, vascular, neural, intraperitoneal, and intraductal routes. The most commonly involved organ is the liver followed by regional lymph nodes. Extra-abdominal metastases are comparatively rare. We present a case of solitary breast metastasis from recurrent gallbladder carcinoma mimicking a primary breast cancer in (18)F-FDG PET/CT.
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Joshi MK, Joshi R, Chadha M, Alam SE, Varshneya H, Kumar S. Gall bladder carcinoma presenting with spinal metastasis: a rare phenomenon. Indian J Palliat Care 2013; 19:113-5. [PMID: 24049354 PMCID: PMC3775021 DOI: 10.4103/0973-1075.116711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Skeletal metastasis as a primary presentation of gall bladder carcinoma is rare. A 50-year-old lady presented with neck pain and weakness in her right upper limb of 3 months duration. Clinical and imaging work-up suggested locally advanced gall bladder carcinoma with metastasis to cervical vertebra and sternum. Only one case till date has been reported where the patient presented with neurological symptoms due to pathological fracture secondary to metastasis from an occult gall bladder carcinoma. Although rare, an occult gall bladder cancer may present with neurological symptoms due to pathological fracture of spine secondary to metastasis. We present a brief review of literature of patients who presented with skeletal metastases in clinically silent gall bladder malignancy. Palliative care issues in advanced gall bladder carcinoma have also been discussed.
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Affiliation(s)
- Mohit K Joshi
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Chiu CS, Lin CY, Kuo TT, Kuan YZ, Chen MJ, Ho HC, Yang LC, Chen CH, Shih IH, Hong HS, Chuang YH. Malignant cutaneous tumors of the scalp: A study of demographic characteristics and histologic distributions of 398 Taiwanese patients. J Am Acad Dermatol 2007; 56:448-52. [PMID: 17141358 DOI: 10.1016/j.jaad.2006.08.060] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 08/04/2006] [Accepted: 08/17/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The scalp is a unique anatomic region, in which pilosebaceous follicles are concentrated. OBJECTIVE We sought to investigate demographic characteristics and histologic distributions of malignant scalp tumors. METHODS Primary and metastatic scalp malignancies diagnosed histopathologically between 1983 and 2003 were reviewed. Age at diagnosis, sex, and histologic types were analyzed. RESULTS A total of 398 Taiwanese patients (200 males, 198 females) were selected. Age at diagnosis ranged from 3 to 103 years. Most malignant scalp tumors (69.8%) occurred in those 50 years or older. Basal (41.2%) and squamous (16.6%) cell carcinomas were the most common histologic types. Surprisingly, metastatic tumors (12.8%) came in third, in which lung cancers were the most frequent primary tumor in both male and female patients. LIMITATIONS In our series, the case number of metastatic scalp malignancies was underestimated because not all patients with metastatic scalp tumors received a scalp skin biopsy. CONCLUSION Because a wide spectrum of primary and metastatic malignancies can occur on the scalp, scalp inspection should be included in general screening for either skin or internal cancers.
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Affiliation(s)
- Cheng-Sheng Chiu
- Department of Dermatology, Min-Sheng General Hospital, Taoyuan, Taiwan
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