Abstract

Renal cell carcinoma most commonly metastasizes to liver, lung, bone and adrenals. Unusual sites of metastasis include urinary and skin. We present a case of 48 years old lady who during follow up after radical nephrectomy for renal cell carcinoma developed metastasis in gallbladder. Very few incidences have been documented in the literature.

Introduction

Twenty five percent of renal cell carcinomas present with metastasis [1]. Common metastatic sites include liver, lung, bone, lymph nodes, brain and adrenals[2]. However, metastases to the urinary bladder and skin have been documented[3]. This is a report of a case with metastasis to the gallbladder in a women who was followed up after radical nephrectomy for RCC. Interestingly all these cases so far reported have been of male patients[4] .

Case Report

A 48 years old lady was found to have a solid looking mass in the upper pole of the left kidney on ultrasound which was done for microscopic haematuria. Contrast enhanced CT Scan confirmed the localized nature of this renal mass consistent with features of renal cell carcinoma with no evidence of local or distant metastasis. The histology of her radical nephrectomy specimen confirmed conventional RCC (pT1, Fuhrmann grade 4). Her follw-up surveillance scans were normal till at 30 months when a 1.2 cm nodule in gallbladder. There was no evidence of recurrence/ metastasis elsewhere. An ultrasound suggested this nodule to be homogenous with increased vascular flow . She underwent laproscopic cholecystectomy and the histology of specimen confirmed secondary deposit from renal cell cancer with no breach of gallbladder wall. She is being followed-up with regular imaging and the last scans 36 months post surgery has been clear.

Figure 1: Scan at 18 months not showing any Metastasis in Gallbladder

Figure 2: Scan at 30 months showing nodule in Gallbladder

Discussion

Renal cell carcinoma accounts for nearly 85 % of all primary kidney neoplasms. A review of the literature picked up 13 cases with gall bladder metastatis from primary renal cell cancer with metastasis in gall bladder. Interestingly all these cases were of male patients[4]. The most common primary with metastasis to gall bladder in malignant melanoma [2]. Patients with gallbladder metastasis can present with abdominal pain mimicking acute or chronic cholecystitis or it can be completely incidental finding at surveillance scans [5]. As these patients are usually followed up with interval scans to look for metastasis its important for radiologists and urologists to look for any suspicious lesion in abdominal viscera which can be unusual secondaries.

References