Metastatic ovarian cancer to the gallbladder indicative of the diagnosis

Ovarian cancer is a malignant tumor that usually develops from the surface coating of the ovaries. The most common form is epithelial carcinoma. As a result of its location, and its silent nature responsible for a delay in diagnosis that makes the prognosis rather poor. The usual metastatic sites are the peritoneal cavity, liver and lung. Secondary biliary localization is a rare, even exceptional site. We report the observation of a patient who presented with abdominal pain in the right hypochondrium and progressive vomiting. Abdominal ultrasound revealed a 21 mm gallbladder lithiasis with hepatic steatosis. Abdominal CT scan revealed a large heterogeneous mass with engulfed gallstones. The patient underwent cholecystectomy. Histological study showed moderately differentiated adenocarcinoma and acute cholecystitis. Immunohistochemical staining revealed that the tumor cells were positive for antibodies against CK7, WT1, PAX8 and p53 and negative for CK20 and ER. These results suggest that the tumor was a metastasis of serous ovarian adenocarcinoma. Medical imaging done with abdominal CT showed an ovarian mass with peritoneal carcinosis, serum CA125 was elevated at 97U/ml. Carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) levels were normal. The patient received first-line chemotherapy with carboplatin and paclitaxel. After 6 courses of therapy, she achieved a partial clinical, biological and radiological response, in our medical oncology department of the CHU Hassan II from Fez. The interest of the subject is to report the rarity of this entity as well as the radiological, histopathological, prognostic and therapeutic characteristics.

The relationship between nephro- and cholelithiasis

The phenomenon of the often occurring coexistence of renal and gallbladder lithiasis, which has long been known to clinicians, prompted Chauifard and Debray (Presse med., 1925, No. 9) to investigate the question of whether there is a relationship between them.

Granulomatous lithiasic cholecystitis in sarcoidosis

Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis diagnosed more than 20-years previously. 2-years previously the patient showed renal lithiasis, hypercalcemia and, increased angiotensin converting enzyme. The imaging features suggested thoraco-abdominal sarcoidosis. Prednisone was given at 1.2 mg/kg/day initially, than decreased, being at 2.5 mg/day at present. The ultrasound examination showed gallbladder lithiasis. A cholecystectomy was performed. Microscopy showed subacute and chronic cholecystitis with several epithelioid and giant cell granulomas some of them perineural. In conclusion, we report a case of granulomatous cholecystitis occurring in the course of treated sarcoidosis. The perineural location of granulomas may give further insights into the pathogenesis of gallbladder dysmotility.

Lipid Histiocytosis of the Gallbladder Neck Lymph Node

Lipid histiocytosis of the gallbladder neck lymph node is rarely reported nowadays. Two obese patients presented with gallbladder lithiasis detected on CT scan. The treatment consisted in coelioscopic cholecystectomy. Microscopy revealed subacute/chronic lithiasic cholecystitis and foci of vacuolated cells in the gallbladder neck lymph node. These cells were positive for CD68, CD31, S100 protein, and adipophilin and negative for cytokeratin and Alcian blue. In conclusion, we report lymph node lipid histiocytosis diagnosed microscopically after cholecystectomy. While such lesions may remain unidentified on imaging procedures, the microscopic analysis may require special stains and immunohistochemistry for ruling out adenocarcinoma metastasis.

One, Two, or Three Ports in Laparoscopic Cholecystectomy?

Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data.