Late port-site metastasis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy: A case report. 2024

Abdullah Aloraini, and Khaled Alshehri, and Rahaf Alshammari, and Abdulhakim Bin Onayq, and Mohammed Ayesh, and Malak Alzahrani, and Sulaiman A AlShammari, and Faisal Alsaif
General, HPB & Transplant Surgeon, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%. METHODS We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior. METHODS Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy. METHODS Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed. RESULTS Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy. CONCLUSIONS Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009366 Neoplasm Seeding The local implantation of tumor cells by contamination of instruments and surgical equipment during and after surgical resection, resulting in local growth of the cells and tumor formation. Seeding, Neoplasm
D005706 Gallbladder Neoplasms Tumors or cancer of the gallbladder. Cancer of Gallbladder,Gallbladder Cancer,Cancer of the Gallbladder,Gall Bladder Cancer,Neoplasms, Gallbladder,Bladder Cancer, Gall,Bladder Cancers, Gall,Cancer, Gall Bladder,Cancer, Gallbladder,Cancers, Gall Bladder,Cancers, Gallbladder,Gall Bladder Cancers,Gallbladder Cancers,Gallbladder Neoplasm,Neoplasm, Gallbladder
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000230 Adenocarcinoma A malignant epithelial tumor with a glandular organization. Adenocarcinoma, Basal Cell,Adenocarcinoma, Granular Cell,Adenocarcinoma, Oxyphilic,Adenocarcinoma, Tubular,Adenoma, Malignant,Carcinoma, Cribriform,Carcinoma, Granular Cell,Carcinoma, Tubular,Adenocarcinomas,Adenocarcinomas, Basal Cell,Adenocarcinomas, Granular Cell,Adenocarcinomas, Oxyphilic,Adenocarcinomas, Tubular,Adenomas, Malignant,Basal Cell Adenocarcinoma,Basal Cell Adenocarcinomas,Carcinomas, Cribriform,Carcinomas, Granular Cell,Carcinomas, Tubular,Cribriform Carcinoma,Cribriform Carcinomas,Granular Cell Adenocarcinoma,Granular Cell Adenocarcinomas,Granular Cell Carcinoma,Granular Cell Carcinomas,Malignant Adenoma,Malignant Adenomas,Oxyphilic Adenocarcinoma,Oxyphilic Adenocarcinomas,Tubular Adenocarcinoma,Tubular Adenocarcinomas,Tubular Carcinoma,Tubular Carcinomas
D017081 Cholecystectomy, Laparoscopic Excision of the gallbladder through an abdominal incision using a laparoscope. Cholecystectomy, Celioscopic,Laparoscopic Cholecystectomy,Celioscopic Cholecystectomies,Celioscopic Cholecystectomy,Cholecystectomies, Celioscopic,Cholecystectomies, Laparoscopic,Laparoscopic Cholecystectomies
D033162 Incidental Findings Unanticipated information discovered in the course of testing or medical care. Used in discussions of information that may have social or psychological consequences, such as when it is learned that a child's biological father is someone other than the putative father, or that a person tested for one disease or disorder has, or is at risk for, something else. Incidental Discovery,Discoveries, Incidental,Discovery, Incidental,Finding, Incidental,Findings, Incidental,Incidental Discoveries,Incidental Finding
D034861 Abdominal Wall The outer margins of the ABDOMEN, extending from the osteocartilaginous thoracic cage to the PELVIS. Though its major part is muscular, the abdominal wall consists of at least seven layers: the SKIN, subcutaneous fat, deep FASCIA; ABDOMINAL MUSCLES, transversalis fascia, extraperitoneal fat, and the parietal PERITONEUM. Wall, Abdominal

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