Bone Marrow Metastases in an Otherwise Operable Gall Bladder Cancer: Rare Site of Distant Metastases Detected on FDG PET/CT

Gallbladder carcinoma presenting with disseminated bony metastasis

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.

Gallbladder Carcinoma Presenting With Elbow Swelling

Common presentation of primary gallbladder carcinoma is with abdominal pain, or it may be detected incidentally in postcholecystectomy specimen for cholelithiasis. Primary gallbladder carcinoma spreads to adjacent hepatic parenchyma and locoregional nodes. Lung is a common extra-abdominal site, with other sites being relatively rare. We report a case of primary gallbladder carcinoma, which presented with elbow swelling in the absence of locoregional nodal spread detected on whole-body F-FDG PET/contrast-enhanced CT at initial evaluation.

Skeletal Metastasis From Carcinoma of the Gall Bladder: Need for Bone Scintigraphy Justified?

Background

Carcinoma of the gall bladder has a guarded prognosis with predominant sites of involvement being liver and regional nodes. Osseous metastasis in carcinoma of the gall bladder is rare and hence bone scintigraphy does not form a part of the routine work-up for such patients.

Case Reports

We describe two patients with carcinoma of the gall bladder with osteolytic metastasis (stage 4). Conservative treatment was planned but both of them succumbed to the illness.

Conclusions

We thus highlight the importance of performing a bone scan or PET CT in cases of carcinoma of the gall bladder. Besides, our cases challenge Paget’s seed – soil theory for sites of metastasis.