Synchronous Gallbladder Cancer and Cholangiocarcinoma: Bad Luck or Good Chance?

Abstract

Introduction: Biliary cancers are a diverse group of tumors that arise from the bile duct epithelium, that includes from intrahepatic or extrahepatic cholangiocarcinoma to gallbladder cancer. Despite improvements in treatment and diagnosis, they are often diagnosed at an advanced stage and associated with poor prognosis with limited treatment options. Simultaneous presence of cancer in the gallbladder and in the biliary tree could be due synchronous malignancies, local invasion (peri-neural, lymphatic or vascular) or to metastasis. Methods: Case report of synchronous gallbladder cancer and cholangiocarcinoma and literature review. Results: The authors present a clinical case of a 68 years old male patient referred to our hepatobiliary surgery unit because of an suspicious polyp on the anterior wall of the gallbladder diagnosed by ultrasound. MRI described a simple gallbladder polyp and no other doubtful findings. Patient was submitted to a laparoscopy cholecystectomy. Histopathology reveled a gallbladder adenocarcinoma. Patient was proposed to hepatoduodenal ligament lymphadenectomy and hepatic segmentectomy, of IV and V segments. There were no metastatic lymph nodes but a intrahepatic cholangiocarcinoma was noticed. Histopathology and metastatic workup revealed a moderately differentiated gallbladder adenocarcinoma (T2a G2 N0 ILV0 IPN0 M0) and moderately differentiated intrahepatic cholangiocarcinoma (T1a N0 ILV0 IPN0 M0). Conclusion: It is possible for two different foci of malignancy to arise within the same dysplastic environment. In this case, the absence of continuousness between the two tumors, the nonexistence lymph node extension, vascular or peri-neural invasion favors the hypothesis of synchronous neoplasms. It is essential for the clinician, as well as, the pathologist to maintain a high index of suspicion while evaluating such lesions.