Gallbladder metastases are rare and usually represent an advanced and end-stage of malignancy. Malignant melanoma and gastric carcinoma account for the most common primary malignancies to see metastases to the gallbladder, in the Western and Asian societies, respectively.
They represent <5% of all gallbladder cancers 1.
Most patients with gallbladder metastases are asymptomatic, and the metastases are detected on surveillance or staging imaging.
Acute cholecystitis is the most common symptomatic presentation of gallbladder metastases, so right upper quadrant pain and a positive Murphy's sign may be present 2. Jaundice is also common. Liver function test derangement and raised inflammatory markers (e.g. CRP) may also be found 2.
The most common primary malignancy in Western society metastasizing to the gallbladder is malignant melanoma, which represents 50-67% of cases 3,8. In Asian society, the most common is gastric cancer 1,8.
Other malignancies metastasizing to the gallbladder include lung cancer, renal cell carcinoma 4, hepatocellular carcinoma 6, and non-Hodgkin lymphoma 7. Most commonly the metastases are caused by haematogenous spread, this produces serosal tumor deposits in the gallbladder, which develop into rapidly growing polypoid masses often with areas of internal hemorrhage 4. In one study it was diagnosed synchronously in one-third of cases and metachronously in two-thirds of patients 4.
One or more hyperechoic masses, usually larger than 1 cm in diameter, with a broad base and minimal acoustic shadowing. In cases of concurrent acute cholecystitis, mural thickening may be seen. Doppler may show abnormal flow within the lesion 4.
One or more enhancing polypoid masses within the gallbladder, often with associated mural thickening 4. The enhancement varies:
- hypervascular lesions with arterial enhancement and early washout are likely related to melanoma, HCC, or RCC as a primary 8
- portal venous persistent enhancement is more commonly seen in metastases from gastrointestinal tract adenocarcinomas 8
- T1: often hyperintense when related to melanin or hemorrhagic content (e.g. melanoma and RCC as primaries) 4
- T2: hypointense 4
However, in the presence of internal hemorrhage, the signal may be heterogeneous and be different from that described above 5.
Treatment and prognosis
Although the primary malignancy is often advanced at the time when gallbladder metastases are diagnosed, cholecystectomy may offer a survival benefit 4.
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- 2. Anita Andreano, Paul Laeseke, Massimiliano Lava, Fabrizio Zimbaro, Vicentini Daniela, Maria Franca Meloni. Asymptomatic Metastatic Melanoma of the Gallbladder Diagnosed With Contrast‐Enhanced Ultrasonography. (2010) Journal of Ultrasound in Medicine. 29 (7): 1133. doi:10.7863/jum.2010.29.7.1133
- 3. Backman H. Metastases of malignant melanoma in the gastrointestinal tract. (1969) Geriatrics. 24 (8): 112-20. Pubmed
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- 5. Yukihisa Takayama, Yoshiki Asayama, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Daisuke Kakihara, Atsushi Sugitani, Yoichi Moroi, Takashi Eguchi, Hiroshi Honda. Metastatic melanoma of the gallbladder. (2007) Computerized Medical Imaging and Graphics. 31 (6): 469. doi:10.1016/j.compmedimag.2007.03.005 - Pubmed
- 6. Barretta ML, Catalano O, Setola SV, et al. Gallbladder metastasis: spectrum of imaging findings. (2011) Abdominal imaging. 36 (6): 729-34. doi:10.1007/s00261-011-9696-y - Pubmed
- 7. Barretta ML, Catalano O, Setola SV,et al. Gallbladder metastasis: spectrum of imaging findings. (2011) Abdominal imaging. 36 (6): 729-34. doi:10.1007/s00261-011-9696-y - Pubmed
- 8. Argha Chatterjee, Camila Lopes Vendrami, Paul Nikolaidis, Pardeep K. Mittal, Andrew J. Bandy, Christine O. Menias, Nancy A. Hammond, Vahid Yaghmai, Guang-Yu Yang, Frank H. Miller. Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances. (2019) RadioGraphics. 39 (2): 388-412. doi:10.1148/rg.2019180164 - Pubmed