Zagouri Flora, Sergentanis Theodoros N, Koulocheri Dimitra, Nonni Afroditi, Bousiotou Aggeliki, Domeyer Philip, Michalopoulos Nikolaos V, Dardamanis Dimitrios, Konstadoulakis Manousos M, Zografos George C
Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Greece.
World J Surg Oncol. 2007 Sep 11;5:101. doi: 10.1186/1477-7819-5-101.
Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare.
A 59-year-old woman presented with bilateral synchronous breast lesions. A palpable, retroareolar solid lesion of diameter equal to 5 cm was present in the right breast, and a newly developed, non-palpable lesion with microcalcifications (diameter equal to 0.7 cm) was present in the upper outer quadrant of the left breast. Modified radical mastectomy was performed on the right breast and lumpectomy after hook-wire localization was performed on the left breast, combined with lymph node dissection in both sides. The pathological examination revealed invasive lobular carcinoma grade II in the right breast and invasive ductal carcinoma grade I in the left breast. Chemotherapy, radiation therapy, trastuzumab and letrozole were appropriately administered. At her 18-month follow-up, the patient was free of symptoms; the imaging tests (chest CT, abdominal U/S, bone scan), biochemical tests, blood cell count and tumor markers were also normal. At the 20th month after surgery however, the patient developed symptoms of cholecystitis and underwent cholecystectomy. The histopathological examination revealed metastasis of the lobular carcinoma to the gallbladder.
This extremely rare case confirms on a single patient the results of large series having demonstrated the preferential metastasis of lobular breast cancer to the gallbladder. Symptoms of cholecystitis should not be neglected in such patients, as they might indicate metastasis to the gallbladder.
乳腺癌通常会转移至肺、骨和肝脏。乳腺癌转移至胆囊极为罕见。
一名59岁女性出现双侧同步乳腺病变。右乳可触及一个直径为5厘米的乳晕后实性病变，左乳外上象限出现一个新发生的、不可触及的伴有微钙化的病变（直径为0.7厘米）。对右乳实施改良根治性乳房切除术，对左乳在钩线定位后行肿块切除术，并同时进行双侧淋巴结清扫。病理检查显示右乳为II级浸润性小叶癌，左乳为I级浸润性导管癌。给予了适当的化疗、放疗、曲妥珠单抗和来曲唑治疗。在18个月的随访中，患者无症状；影像学检查（胸部CT、腹部超声、骨扫描）、生化检查、血细胞计数和肿瘤标志物均正常。然而，在术后第20个月，患者出现胆囊炎症状并接受了胆囊切除术。组织病理学检查显示小叶癌转移至胆囊。
这一极其罕见的病例在单一患者身上证实了大量系列研究的结果，这些研究表明小叶型乳腺癌易转移至胆囊。在此类患者中，胆囊炎症状不应被忽视，因为它们可能提示胆囊转移。
