Abstract
Synchronous tumors in both the rectum and the gallbladder are extremely rare. This study reports a case of gallbladder and rectal synchronic tumors, histopathologically confirmed, and discusses the therapeutic strategies in managing multiple primary cancers. Patient files from the Patient Files and Statistical Department of the University Hospital João de Barros Barreto and review of English literature were analyzed. Data from a case of a 69-year-old female patient with compressive vaginal and anal pain, constipation, and hematochezia were reviewed. Rectal touch evidenced a vegetating and infiltrative tumoral lesion, and colonoscopy demonstrated an elevated, vegetating, and infiltrative lesion. The histopathological analyses confirmed a moderately differentiated adenocarcinoma. A preoperative computer tomography scan was negative for metastasis investigation and, as an incidental finding, demonstrated cholelithiasis. The histological evaluation of the surgical specimens demonstrated rectal cancer, gallbladder cancer, and also hepatic metastasis. Due to the presence of hepatic and rectal cancer metastases, the standard management of the gallbladder cancer was modified according to the general concept that radical treatment of synchronous tumors should be reserved to situations were all tumors can be treated curatively or can improve life expectancy. Primary gallbladder and rectal synchronous neoplasms are rare and the treatment must be specific to each tumor, following the guidelines of each cancer whenever feasible. In case of metastasis or advanced stages of the disease, the treatment strategies must consider the most advanced tumor and/or the worst prognosis, and aggressive procedures must be avoided when it is not possible to radically treat every synchronous tumor.
Highlights
Colorectal cancer (CRC) is the third most frequent cancer type among the sporadic malignant cancers and accounts for 11% of cancer deaths
A Japanese study done by Horii et al evidenced that microsatellite instabilities were frequently observed in multiple primary neoplasms rather than in single neoplasms[2,8]
The Warren and Gates criteria define synchronic tumors and can be applied if a second primary tumor falls into these criteria: (a) each tumor should represent a single form of malignancy; (b) each tumor has to be distinct from each other; and/or (c) the metastatic tumor should be excluded[1,7]
Summary
Colorectal cancer (CRC) is the third most frequent cancer type among the sporadic malignant cancers and accounts for 11% of cancer deaths. Almost 40% of multiple primary tumors involving gallbladder cancer are associated to gastric cancer and 30% to colon cancer[7]. As for the family cancer history (Figure 1): her mother and grandmother had liver neoplasms, her aunt and brother had colonic neoplasms She was in good clinical condition but the rectal touch exam evidenced an infiltrative and vegetating tumoral lesion at the lower rectum attached to its epithelium, occupying 75% of its lumen. The patient underwent Miles surgery in addition to cholecystectomy and liver biopsy of the left lobe nodule (Figure 2B) She recovered very well from the surgery, without any type of complication and with early hospital discharge on the 4th postoperative day. Histopathology of the gallbladder evidenced moderately differentiated adenocarcinoma (Figure 2C), reaching to the muscular layer with no lymph nodal, angiolymphatic, or perineural invasion, T2N0 (stage IA). The liver nodules reveled an adenocarcinoma, with a moderately differentiated pattern showing tumor vessel emboli
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