Synchronous double primary malignant tumor of the gallbladder and liver: a case report
© Kim et al; licensee BioMed Central Ltd. 2011
Received: 18 April 2011
Accepted: 3 August 2011
Published: 3 August 2011
We report a case of synchronous double primary tumor of gallbladder and liver. A 63-year-old male was admitted to the hospital complaining of abdominal discomfort. Enhanced computed tomography of the abdomen showed acute cholecystitis with tiny gallbladder stones and a 2.2 cm size enhanced nodule in the left lobe of the liver. Under the impression of acute cholecystitis with gall bladder stones and hepatocellular carcinoma of the left Liver, the patient underwent a laparotomy. At laparotomy, a mass was palpated on the surface of the neck portion of the gall bladder. Intraoperative frozen diagnosis revealed adenocarcinoma of the gall bladder. The patient was diagnosed as having gall bladder cancer and hepatocellular carcinoma, so extended cholecystectomy with dissection of regional lymph nodes and left hemihepatectomy were performed. Histological examination revealed moderated differentiated adenocarcinoma of gallbladder and hepatocellular carcinoma of liver. To our knowledge, the simultaneous occurrence of primary malignant tumor of the gallbladder and liver has never been published before. The patient is doing well with no evidence of recurrence 17 months after surgery.
Synchronous double primary malignant neoplasms are a secondary malignancy occurring at the same time or within 6 months after the first malignancy. Improvement of survival rates for patients with malignancy due to early diagnosis and new treatments has enabled more patients to survive long enough to develop the subsequent primary malignancy, and development of more sophisticated diagnostic tools has made possible the detection of synchronous occult malignancies. Synchronous double primary malignant neoplasms in a single patient have been well-documented in the literature. But, synchronous double primary malignant tumor of gallbladder and liver has never been reported. Herein, the authors report a case of a 63-year-old male patient with double primary cancer of gallbladder and liver.
Multiple primary malignant tumors in a single patient are relatively rare. In reviews of the literature regarding multiple primary malignant tumors, the overall occurrence rate of multiple primary malignancies is between 0.73% and 11.7% . Multiple primary cancers have become more common because of an increase in the number of elderly patients and advancement in diagnostic techniques. Three diagnostic criteria have been proposed for multiple primary malignancy: 1) each tumor must present definite features of malignancy, 2) each must be distinct, and 3) the chance of one being a metastasis of the other must be excluded . Multiple primary cancers may be synchronous or metachronous depending on the interval between their diagnosis. Synchronous cancers are second tumors occurring simultaneously or within 6 months after the first malignancy, while metachronous multiple malignancies are secondary cancers that developed after more than 6 months after from the first malignancy . Multiple primary malignancies are classified into four types: 1) multicentric, if the two distinct carcinoma arise in the same organ or tissue; 2) systemic, if they arise on anatomically or functionally allied organs of the same system (colon and rectum cancers), 3) paired organs, as in the breasts, and 4) random, if they occur as a co-incidental or accidental association in unrelated sites . In our patient, the malignant features were histopathologically proven in each tumor. Each tumor was pathologically categorized as a different type; namely, the one detected in the gall bladder was a moderately differentiated adenocarcinoma, the one in the liver was a hepatocellular carcinoma. These findings might also support the fact that these two cancers occurred in a random and synchronous manner. There was one case reported in the literature who had synchronous triple primary cancers of gallbladder, common bile duct and liver in a women with primary biliary cirrhosis . In our case, two different type malignant tumors, adenocarcinoma of gallbladder and hepatocellular carcinoma, were observed in a male patient without primary biliary cirrhosis. Hepatocelullar carcinoma is known to be pathogenically associated with liver cirrhosis, chronic hepatitis virus infection, and abuse of alcohol . Gallbladders containing stones or infectious agents develop cancer as a result of recurrent trauma and chronic inflammation. Although the mechanism involved in the development of multiple primary cancer has not been clarified, some factors such as heredity, constitution, environmental and immunological factors, carcinogenic, viruses, radiological and chemical treatments have been implicated . In the present case, gallbladder stones and chronic hepatitis B virus infection may have played an important role in the pathogenesis of gallbladder adenocarcinoma and hepatocellular carcinoma, respectively. The prognosis of patients with multiple primary malignant tumors can be determined independently by the stage of each malignancies. In the present case, adenocarcinoma of gall bladder was T2N0M0 (stage II) and hepatocellular carcinoma was T1N0M0 (stage I). The surgical treatment of choice for synchronous multiple primary malignancies is curative resection of each malignant tumors .
We report the first case of synchronous double primary malignancies of gallbladder and liver. The possibility of synchronous multiple primary malignancies should be noted in the treatment of elderly patients with malignant tumor. Multiplicity of primary malignancies itself does not necessarily indicate a poor prognosis as long as adequate diagnosis and treatment are performed.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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