Gastric Cancer Complicated by Synchronous Gallbladder Metastasis

Only 11 cases of gallbladder metastasis, an extremely rare gastric cancer, have been reported in Japan. A 66-year-old Japanese woman with gastric cancer complicated by gallbladder metastasis was preoperatively diagnosed with scirrhous gastric cancer free of noncurative factors such as peritoneal dissemination and distant metastasis. She underwent total gastrectomy, regional lymphadenectomy, splenectomy, and prophylactic cholecystectomy after neoadjuvant chemotherapy with TS-1 and CDDP. No macroscopic gallbladder abnormality was found but gastric cancer cells found in a histological examination to have spread to the gallbladder muscle layer were not considered part of direct invasion from either a primary tumor or peritoneal dissemination. They were, instead, thought to be lymphogenous gallbladder metastasis from gastric cancer because lymphatic invasion and lymphatic dilation were seen in the primary gastric lesion. The final histological diagnosis was poorly differentiated adenocarcinoma, T2 (SS), ly1, v0, N1, H0, P1, CY0, M1 (gallbladder) and the histological response to neoadjuvant chemotherapy was evaluated as Grade 2. Although no adjuvant chemotherapy was done due to anorexia symptoms, she remains alive without recurrence in the 1 year since surgery. We discuss clinicopathological features with a review of the literature.