Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5729-5736
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5729
Port-site metastasis of unsuspected gallbladder carcinoma with ossification after laparoscopic cholecystectomy: A case report
Kai-Jun Gao, Zhi-Long Yan, Yu Yu, Liang-Qi Guo, Chen Hang, Jia-Bin Yang, Mou-Cheng Zhang
Kai-Jun Gao, Liang-Qi Guo, Chen Hang, Jia-Bin Yang, Medical School of Ningbo University, Ningbo University, Ningbo 315211, Zhejiang Province, China
Zhi-Long Yan, Mou-Cheng Zhang, Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
Yu Yu, Department of Gastrointestinal Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
Author contributions: Gao KJ and Zhang MC designed the report; Zhang MC and Yan ZL performed the surgery; Yu Y reviewed the literature and contributed to drafting the manuscript; Guo LQ analyzed and interpreted the imaging findings; Hang C performed the pathology analyses; Yang JB was responsible for the revision of the manuscript for important content; Gao KJ wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mou-Cheng Zhang, MD, Professor, Surgeon, Department of Gastrointestinal Surgery, Ningbo First Hospital, No. 59 Liuting Road, Ningbo 315000, Zhejiang Province, China. zhangmoucheng200@163.com
Received: August 21, 2020
Peer-review started: August 21, 2020
First decision: September 12, 2020
Revised: September 23, 2020
Accepted: October 1, 2020
Article in press: October 1, 2020
Published online: November 26, 2020
Processing time: 95 Days and 22.5 Hours
Abstract
BACKGROUND

Unsuspected gallbladder carcinoma (UGC) refers to cholecystectomy due to benign gallbladder disease, which is pathologically confirmed as gallbladder cancer during or after surgery. Port-site metastasis (PSM) of UGC following laparoscopic cholecystectomy is rare, especially after several years.

CASE SUMMARY

A 55-year-old man presenting with acute cholecystitis and gallstones was treated by laparoscopic cholecystectomy in July 2008. Histological analysis revealed unexpected papillary adenocarcinoma of the gallbladder with gallstones, which indicated that the tumor had spread to the muscular space (pT1b). Radical resection of gallbladder carcinoma was performed 10 d later. In January 2018, the patient was admitted to our hospital for a mass in the upper abdominal wall after surgery for gallbladder cancer 10 years ago. Laparoscopic exploration and complete resection of the abdominal wall tumor were successfully performed. Pathological diagnosis showed metastatic or invasive, moderately differentiated adenocarcinoma in fibrous tissue with massive ossification. Immuno-histochemistry and medical history were consistent with invasion or metastasis of gallbladder carcinoma. His general condition was well at follow-up of 31 mo. No recurrence was found by ultrasound and epigastric enhanced computed tomography.

CONCLUSION

PSM of gallbladder cancer is often accompanied by peritoneal metastasis, which indicates poor prognosis. Once PSM occurs after surgery, laparoscopic exploration is recommended to rule out abdominal metastasis to avoid unnecessary surgery.

Keywords: Port-site metastasis; Unsuspected gallbladder carcinoma; Heterotopic ossification; Laparoscopic cholecystectomy; Case report; Literature review

Core Tip: Port-site metastasis of unsuspected gallbladder carcinoma occurring several years after laparoscopic cholecystectomy is rare. It is often accompanied by peritoneal metastasis with poor prognosis. We report a case of a 55-year-old man with port-site metastasis after surgery for gallbladder cancer 10 years ago. Complete resection of an abdominal wall tumor was successfully performed with no recurrence after 31 mo. Although recurrence of unsuspected gallbladder carcinoma is rare, physicians should remain vigilant for this possibility. Once port-site metastasis occurs after surgery, laparoscopic exploration or positron emission tomography/computed tomography is recommended to rule out abdominal metastasis. Complete tumor resection can improve prognosis.