Subcutaneous and breast metastasis from asymptomatic gallbladder carcinoma

Though gallbladder carcinoma is associated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is lung. Gallbladder carcinoma metastasizing to breast and subcutaneous tissue is not known.

This report describes an interesting and unusual case of asymptomatic gallbladder carcinoma presenting with subcutaneous and breast metastasis.

A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall, anterior chest wall, back and in bilateral breasts. Fine needle aspiration cytology (FNAC) of these nodules revealed metastatic adenocarcinoma. The patient was investigated for a primary neoplasm. An ultrasound of the abdomen followed by a contrast-enhanced CT scan showed a growth in gallbladder, infiltrating the liver with multiple hepatic metastases. CT-guided FNAC from the growth in the gallbladder revealed adenocarcinoma. She was diagnosed as a case of metastatic adenocarcinoma of the gallbladder and palliative combination chemotherapy with gemcitabine and carboplatin was given. But she developed jaundice and deteriorated dramatically in a short span of time. No specific therapy could be started and she was given supportive treatment. She died within three weeks of diagnosis due to hepatic encephalopathy.

This report highlights an unusual metastasis of gallbladder carcinoma to the breast and subcutaneous tissue presenting as multiple lesions, which has never been reported in the English literature. These were unknown sites of metastasis for carcinoma of the gallbladder. Moreover, bilateral multiple metastatic lesions to breast are also very rare.