The Other Bladder: A Case of Prostatic Adenocarcinoma Metastasis to the Gallbladder

Jennifer Kent Patrick J Fox

doi:10.4172/2165-7920.1000456

Abstract

Prostate cancer metastasis to bone and lymph nodes is common, but metastasis to the gallbladder is rare. We report a case of a 72 year-old-male with a three month history of weight loss and nausea. On further evaluation he was found to have an elevated alkaline phosphatase and radiographic evidence of prostate cancer, skeletal metastases, and a gallbladder mass concerning for concomitant gallbladder carcinoma. Prostate biopsy confirmed high-grade prostatic adenocarcinoma. The patient underwent laparoscopic cholecystectomy and pathologic evaluation of the gallbladder revealed metastatic prostatic adenocarcinoma without evidence of gallbladder carcinoma. This case demonstrates a possible association between prostatic adenocarcinoma and the gallbladder.

Highlights

Prostate cancer is one of the most common malignancies in the United States
Different malignancies have been reported to metastasize to the gallbladder, including melanoma, renal cell carcinoma, and non-small cell lung carcinoma, and in most cases these patients present with acute cholecystitis [3,4,5,6,7,8,9,10,11]
Maxwell et al presented a case report of an 83 year old male with a history of Gleason 8 prostatic adenocarcinoma, who elected watchful waiting, that presented with signs and symptoms consistent with acute cholecystitis

Summary

Introduction

Prostate cancer is one of the most common malignancies in the United States. In 2014, it is estimated that 233,000 men were diagnosed with prostate cancer, encompassing 14% of all new cancer cases, and 29,480 men died from the disease [1]. We report a case of metastatic prostatic adenocarcinoma to the gallbladder presenting with weight loss and nausea and without acute cholecystitis. A 72-year-old Caucasian male was referred from the outpatient setting for evaluation of weight loss, nausea, and an elevated alkaline phosphatase of 1,287 IU/L His symptoms were concerning for a gastrointestinal malignancy, computed tomography of the abdomen and pelvis was obtained and showed a distended gallbladder with an enhancing soft tissue mass in the gallbladder neck measuring 1.1 cm×0.9 cm (Figure 1A) with no pericholecystic fluid to suggest acute cholecystitis. Histologic evaluation revealed prostatic adenocarcinoma with lymphovascular invasion, without pathologic evidence of gallbladder carcinoma This was confirmed by tumor embolus visualized within the gallbladder (Figure 3A) that stained positive for PSA (Figure 3B), and negative for cytokeratin (Figure 3C), a molecule expressed in normal gallbladder epithelium. At 5 months postoperative, his PSA was 4.10 ng/mL and he was started on denosumab

Discussion

Findings

The endogenous expression of the cell signaling Protein Prostate