The Common Vein Copyright 2008
Alok Anand
Definition
Metastasis is a complication of a primary malignancy whereby cancer ells from a remote or adjacent part of the body seed and grow within or on the gallbladder. 6% of patients with terminal carcinoma at any site have metastases to gallbladder.
The cause of the metastases is usually via hematogenous route and the most common primary sites are melanoma, lung and renal cancer. Transperitoneal spread with implants on the surface of the gallbladder is seen in ovarian, gastric, pancreatic and colonic disease.
Structurally the llesions are nodules or masses and occupy space so they deform and displace normal structures.
Functional changes depend on the mechanism of spread and level of infiltration into the biliary tree. Peritoneal spread does not usually cause obstruction as often as haematogenous spread.
The clinical presentation is non-specific, and often more suggestive of the primary, underlying cancer. Patients may have a painless sub-hepatic mass, depending on tumor size.
The diagnosis of the source of cancer is often made with the help of the clinical presentation and imaging. PET/CT can give useful information of active areas of metabolism. Ultrasound may show a mass with differing echogenicity from the normal gallbladder.
The presence of metastases to the gallbladder implies stage 4 disease and hence is always seen in advanced disease.
Treatment options are often limited, as metastases to the gallbladder timplies stage 4 disease There is consequent poor prognosis.
 Metastasis to Fundus |
| 22705 gallbladder abdomen peritoneum peritoneal cavity fx mass fx calcification fx distortion dx metastatic colon carcinoma large bowel malignant primary compliacated by transperitoneal spread dx metastasis to the gallbladder fundus metastases metastattic fx ascites imaging radiology CTscan C+ CTscan Courtesy Ashley Davidoff MD |
 Metastasis to Fundus |
| 22704c01.8s gallbladder abdomen peritoneum peritoneal cavity fx mass fx calcification fx distortion dx metastatic colon carcinoma large bowel malignant primary compliacated by transperitoneal spread dx metastasis to the gallbladder fundus metastases metastattic fx ascites imaging radiology CTscan C+ CTscan Courtesy Ashley Davidoff MD copyright 2008 |