2316 Gangrenous Cholecystitis and Revelation of Gallbladder Metastasis From Primary Breast Cancer

Abstract

INTRODUCTION: Breast cancer metastasis seeds various organs in the body by gaining access to blood and lymphatic vessels. The preferential sites involve the lung, liver, bone, and brain, and symptoms usually compromise of chest pain, cough, shortness of breath, abdominal pain, and joint pain. Metastasis to the gallbladder is of a rare phenomenon, and here in our case report we present an unusual discovery of gangrenous cholecystitis through diagnostic laparoscopy; with eventual histopathological findings revealing metastatic primary breast cancer to the gallbladder. CASE DESCRIPTION/METHODS: A 59-year-old African American female presented to our institution with 1-day history of abdominal pain. The abdominal pain is of sudden onset, mainly located in the right upper quadrant, sharp/stabbing in nature, intermittent, radiating towards the right flank and was associated with non-bilious/non-bloody vomiting. Medical history included hypertension, hyperlipidemia, myocardial infarction X2, and notably a recent diagnosis of metastatic breast cancer. She was diagnosed 2 months prior to admission with T4N3M1 breast cancer. Labs were significant for AST 89, ALT 68, Alk Phos 178, and albumin 3.4. CT of the chest and abdomen was done which showed re-demonstration of metastatic breast cancer along with marked gallbladder wall thickening without obvious gallbladder calculi. A HIDA scan was performed which excluded cholecystitis. Patient was admitted and was started on intravenous fluids, antibiotics, and pain medications. General surgery was consulted, and decision was made for diagnostic laparoscopy. Laparoscopy revealed perforated acute gangrenous cholecystitis, leading to the removal of gallbladder along with appropriate cleansing of the abdomen. Histopathological examination of gallbladder shows tumor cells positive for GATA3 and ER (greater than 90%) [Figures 1 and 2]. Post operatively patient had no complications and was successfully discharged with close outpatient follow up. DISCUSSION: Metastasis (mets) to the gallbladder is rare, and from breast primary it is considered an extremely rare occurrence. In our case report, we see a patient with history of breast cancer developing symptoms of sudden onset right upper quadrant pain with vomiting and liver derangements. Treatment plans differ for primary gallbladder cancer vs mets to gallbladder; as histochemical testing is the key to accurate diagnosis. Hence, for appropriate treatment plans, clinicians should be aware of unusual presentation of metastatic breast cancer.