Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review
-
Nasieh Sargazi Moghaddam
,
Bita Germizadeh
,
Mahtab Farahangiz
,
Sima Dehghani
,
Mehra Mojallal
,
Farzad Houshdaran
Abstract
Background: Renal cell carcinoma (RCC) is a malignancy known for its high metastatic potential, commonly
spreading to the lungs, bones, brain, liver, and adrenal glands. Gallbladder metastasis from RCC is exceedingly
rare and poses significant diagnostic challenges due to its asymptomatic nature and nonspecific imaging findings.
Case Presentation: We report the case of a 58-year-old Persian man with a history of clear cell RCC treated
with left radical nephrectomy 34 months prior. The patient presented with right upper quadrant abdominal pain. Imaging studies, including contrast-enhanced computed tomography and ultrasound, revealed two hypervascular polypoid lesions within the gallbladder. An open cholecystectomy was performed due to the suspicion of malignancy. Histopathological examination confirmed metastatic clear cell RCC invading the gallbladder wall. Notably, immunohistochemical analysis showed tumor cells positive for cytokeratin 19, alpha-methylacyl- CoA racemase, and vimentin, but negative for paired box gene 8, cytokeratin 7, cytokeratin 20, and cluster of differentiation 117 (C-Kit). The absence of paired box gene 8 expression is atypical for RCC metastasis and posed a diagnostic challenge. The patient had an uneventful postoperative recovery but unfortunately passed away two months later due to a cerebrovascular accident unrelated to his oncological condition.
Conclusions: This case underscores the importance of considering gallbladder metastasis in the differential
diagnosis for patients with a history of RCC presenting with gallbladder lesions. The atypical immunohistochemical profile observed expands the known spectrum of metastatic RCC presentations and highlights the necessity for comprehensive diagnostic evaluation. Surgical intervention through cholecystectomy can lead to favorable outcomes and should be considered in similar cases.
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28. Limani K, Matos C, Hut F, Gelin M, Closset J. Metastatic Carcinoma of the Gallbladder after a Renal Cell Carcinoma. Acta Chir Belg. 2003;103:233-4. https://doi.org/10.1080/00015458.2003.11679414
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34. Nojima H, Cho A, Yamamoto H, Nagata M, Takiguchi N, Kainuma O, et al. Renal cell carcinoma with unusual metastasis to the gallbladder. J Hepatobiliary Pancreat Surg. 2008;15:209-12. https://doi.org/10.1007/s00534-007-1226-5
35. Oba T, Sato N, Tamura T, Fujimoto K, Matsuyama A, Hirata K. Gallbladder metastasis of renal cell carcinoma presenting as a hypervascular polypoid lesion: case report of two cases with immunohistochemical analysis. Surg Case Rep. 2020;6:86-. https://doi.org/10.1186/s40792-020-00814-z
36. Pagano S, Ruggeri P, Franzoso F, Brusamolino R. Unusual renal cell carcinoma metastasis to the gallbladder. Urology. 1995;45:867-9. https://doi.org/10.1016/S0090-4295(99)80097-1
37. Papalampros A, Davakis S, Syllaios A, Vagios I, Diamantopoulou P, Kyros E, et al. Late onset metastasis from renal cell carcinoma masquerading as a gallbladder polyp. Ann R Coll Surg Engl. 2021;103:e13-e6. https://doi.org/10.1308/rcsann.2020.7037
38. Patel S, Zebian B, Gurjar S, Pavithran N, Singh K, Liston T, Grant J. An unusual gall-bladder polyp--site of metastatic renal cell carcinoma: a case report. Cases J. 2009;2:172-. https://doi.org/10.1186/1757-1626-2-172
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42. Satoh H, Iyama A, Hidaka K, Nakashiro H, Harada S, Hisatsugu T. Metastatic carcinoma of the gallbladder from renal cancer presenting as intraluminal polypoid mass. Dig Dis Sci. 1991;36:520-3. https://doi.org/10.1007/BF01298886
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45. Takenaka M, Okabe Y, Kudo M. Hemorrhage from metastasis of a 5-mm renal cell carcinoma lesion to the gallbladder detected by contrast-enhanced endoscopic ultrasonography. Dig Liver Dis. 2019;51:743. https://doi.org/10.1016/j.dld.2018.11.010
46. Ueda I, Aoki T, Oki H, Takahashi H, Hayashida Y, Minagawa N, et al. Gallbladder Metastasis from Renal Cell Carcinoma: A Case Report with Review of the Literature. Magn Reson Med Sci. 2015;14:133-8. https://doi.org/10.2463/mrms.2013-0130
47. Yin J, Li B, Zheng M. Ipsilateral Synchronous Papillary and Clear Cell Renal Cell Carcinoma: a Case Report and Literature Review. Research Square Platform LLC; 2021. https://doi.org/10.21203/rs.3.rs-141433/v1
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2. White I, Smith S, Rizkalla K, Davies E. Unexpected Gallbladder Metastasis of Clear Cell Renal Carcinoma. Clin Pathol. 2019;12:2632010X19861112-2632010X. https://doi.org/10.1177/2632010X19861112
3. Costa Neves M, Neofytou K, Giakoustidis A, Hazell S, Wotherspoon A, Gore M, Mudan S. Two cases of gallbladder metastasis from renal cell carcinoma and review of literature. World J Surg Oncol. 2016;14:87-. https://doi.org/10.1186/s12957-016-0843-3
4. Shyr BU, Chen SC, Shyr YM, Lee RC, Wang SE. Metastatic polyp of the gallbladder from renal cell carcinoma. BMC Cancer. 2017;17:244-. https://doi.org/10.1186/s12885-017-3243-3
5. Akhtar S, Usman A, Sultan A, Khalid W, Siddique K. A Rare Case of Single Gallbladder and Multiple Pancreatic Metastases of Renal Cell Carcinoma. Cureus. 2022;14:e31861-e. https://doi.org/10.7759/cureus.31861
6. Alves Ribeiro M, Petersen da Costa Ferreira C, de Lucia Hernani B, Szutan LA, Galli Mortati MC, Toledo Bueno Pereira F, Kater F. Uncommon site of metastasis from renal cell carcinoma: Case report. Int J Surg Case Rep. 2019;56. https://doi.org/10.1016/j.ijscr.2019.02.013
7. Antonakis P, Alexakis N, Mylonaki D, Leandros E, M Konstadoulakis M, Zografos G, Androulakis G. Incidental finding of gallbladder carcinoma detected during or after laparoscopic cholecystectomy. Eur J Surg Oncol. 2003 May;29(4):358-60. https://doi.org/10.1053/ejso.2002.1402
8. Aoki T, Inoue K, Tsuchida A, Aoki T, Kitamura K, Koyanagi Y, et al. Gallbladder Metastasis of Renal Cell Carcinoma: Report of Two Cases. Surg Today. 2002;32:89-92. https://doi.org/10.1007/s595-002-8123-6
9. Baloğlu MC, Yahşi S, Erol Fenercioğlu Ö, Çermik TF, Ergül N. Gallbladder Metastasis From Renal Cell Carcinoma Revealed With 18F-FDG PET/CT. Clin Nucl Med. 2022;47:e587-e8. https://doi.org/10.1097/RLU.0000000000004226
10. Bolus CC, Libertino JA, Wald C. Metastatic renal clear-cell carcinoma to the gallbladder: A radiologist’s perspective. Radiol Case Rep. 2015;5:362-. https://doi.org/10.2484/rcr.v5i1.362
11. Castro Ruiz C, Pedrazzoli C, Bonacini S. Gallbladder’s clear cell renal carcinoma metastasis: A case report. Int J Surg Case Rep. 2016;18:48-51. https://doi.org/10.1016/j.ijscr.2015.11.021
12. Cheng SC, Chuang CH, Chao CM. Metachronous Metastatic Renal Cell Carcinoma of the Gall Bladder. Am J Med Sci. 2015;350:58. https://doi.org/10.1097/MAJ.0000000000000252
13. Cho SH, Han YS, Han JR, Kwon HJ, Choi SH, Kim HT, et al. Synchronous gallbladder metastasis of renal cell carcinoma presenting as a gallbladder polyp: A case report. Medicine (Baltimore). 2021;100:e24037-e. https://doi.org/10.1097/MD.0000000000024037
14. Chung PH, Srinivasan R, Linehan WM, Pinto PA, Bratslavsky G. Renal cell carcinoma with metastases to the gallbladder: four cases from the National Cancer Institute (NCI) and review of the literature. Urol Oncol. 2012;30:476-81. https://doi.org/10.1016/j.urolonc.2010.04.010
15. Decoene J, Ameye F, Lerut E, Oyen R, Van Poppel H, Joniau S. Renal cell carcinoma with synchronous metastasis to the calcaneus and metachronous metastases to the ovary and gallbladder. Case Rep Med. 2011;2011:671645-. https://doi.org/10.1155/2011/671645
16. Ditah F, Shah RB, Wolf JS. Renal Cell Carcinoma with Synchronous Gallbladder Metastasis Treated with Laparoscopic Radical Nephrectomy and Cholecystectomy in the Same Setting. UroToday Int J. 2008;01. https://doi.org/10.3834/uij.1939-4810.2008.11.04
17. Ghaouti M, Znati K, Jahid A, Zouaidia F, Bernoussi Z, El Fakir Y, Mahassini N. A gallbladder tumor revealing metastatic clear cell renal carcinoma: report of case and review of literature. Diagn Pathol. 2013;8:4-. https://doi.org/10.1186/1746-1596-8-4
18. Harsha SS, Ali S, Singh A, Aggarwal L, Kumar A, Choudhary A, Bansal M. Gallbladder metastasis from primary renal malignancy: case report and review. Int Surg J. 2022;9:1767. https://doi.org/10.18203/2349-2902.isj20222605
19. Hasselblatt GN. Article 49 Publication. Community Des Regul. 2018. p. 404-6. https://doi.org/10.5771/9783845296111-404
20. Hellenthal NJ, Stewart GS, Cambio AJ, DeLair SM. Renal cell carcinoma metastatic to gallbladder: a survival advantage to simultaneous nephrectomy and cholecystectomy. Int Urol Nephrol. 2007;39:377-9. https://doi.org/10.1007/s11255-006-9057-x
21. Hisa T, Takamatsu M, Shimizu T, Gibo N. Chronological changes in the ultrasonic findings of gallbladder metastasis from renal cell carcinoma: a case report and review. J Med Ultrason. 2013;41:371-5. https://doi.org/10.1007/s10396-013-0510-z
22. Ishizawa T, Okuda J, Kawanishi T, Kitagawa T, Sekikawa T, Yakumaru K. Metastatic Renal Cell Carcinoma of the Gallbladder. Asian J Surg. 2006;29:145-8. https://doi.org/10.1016/S1015-9584(09)60074-9
23. Kawahara T, Ohshiro H, Sekiguchi Z, Furuya M, Namura K, Itoh H, et al. Gallbladder Metastasis from Renal Cell Carcinoma. Case Rep Oncol. 2010;3:30-4. https://doi.org/10.1159/000279308
24. Kim CG, Kim SH, Cho SH, Ryeom HK. Gallbladder Metastasis of Renal Cell Carcinoma: A Case Report. J Korean Soc Radiol. 2021;82:959-63. https://doi.org/10.3348/jksr.2020.0053
25. King DHC, Centeno AS, Saldivar VA, Sarosdy MF. Renal cell carcinoma metastatic to the gallbladder or prostate: Two case reports. Urology. 1995;46:722-5. https://doi.org/10.1016/S0090-4295(99)80310-0
26. Kinoshita O, Dohi M, Horii Y, Ikai A, Kitamori T, Yamashita T. Simultaneous resection of gastric and gallbladder metastasis from renal cell carcinoma treated by laparoscopic and endoscopic cooperative surgery: a case report. Surg Case Rep.
27. Kitamura H, Kurokawa M, Inaki N, Bando H. Gallbladder Metastasis from Renal Cell Carcinoma. Indian J Surg. 2018;80:278-80. https://doi.org/10.1007/s12262-017-1705-0
28. Limani K, Matos C, Hut F, Gelin M, Closset J. Metastatic Carcinoma of the Gallbladder after a Renal Cell Carcinoma. Acta Chir Belg. 2003;103:233-4. https://doi.org/10.1080/00015458.2003.11679414
29. Liu F, Li FY, Zhou RX. Unusual case of gallstones with chronic cholecystitis revealing a metachronous gallbladder metastasis from renal clear cell carcinoma. ANZ J Surg. 2019;90. https://doi.org/10.1111/ans.15314
30. McWhirter D, den Dulk M, Terlizzo M, Malik HZ, Fenwick SW, Poston GJ. Renal cell carcinoma metastases to gallbladder. Ann R Coll Surg Engl. 2013;95:e136-e8. https://doi.org/10.1308/003588413X13629960046679
31. Mitsimponas N. Isolated Gallbladder Metastasis from Renal Cell Carcinoma: A Case Report and Review of the Literature. Ann Hematol Oncol. 2017;4. https://doi.org/10.26420/annhematoloncol.2017.1149
32. Moujahid M, Zrara I, Touiti D, Daali M. Métastase vésiculaire d’un cancer du rein. Gastroenterol Clin Biol. 2008;32:788-9. https://doi.org/10.1016/j.gcb.2008.05.013
33. Mrak K, Lackner C, Mischinger HJ, Kornprat P. Metachronous gallbladder metastasis from renal cell carcinoma-a rare clinical manifestation. Wien Klin Wochenschr. 2016;128:669-71. https://doi.org/10.1007/s00508-016-1058-x
34. Nojima H, Cho A, Yamamoto H, Nagata M, Takiguchi N, Kainuma O, et al. Renal cell carcinoma with unusual metastasis to the gallbladder. J Hepatobiliary Pancreat Surg. 2008;15:209-12. https://doi.org/10.1007/s00534-007-1226-5
35. Oba T, Sato N, Tamura T, Fujimoto K, Matsuyama A, Hirata K. Gallbladder metastasis of renal cell carcinoma presenting as a hypervascular polypoid lesion: case report of two cases with immunohistochemical analysis. Surg Case Rep. 2020;6:86-. https://doi.org/10.1186/s40792-020-00814-z
36. Pagano S, Ruggeri P, Franzoso F, Brusamolino R. Unusual renal cell carcinoma metastasis to the gallbladder. Urology. 1995;45:867-9. https://doi.org/10.1016/S0090-4295(99)80097-1
37. Papalampros A, Davakis S, Syllaios A, Vagios I, Diamantopoulou P, Kyros E, et al. Late onset metastasis from renal cell carcinoma masquerading as a gallbladder polyp. Ann R Coll Surg Engl. 2021;103:e13-e6. https://doi.org/10.1308/rcsann.2020.7037
38. Patel S, Zebian B, Gurjar S, Pavithran N, Singh K, Liston T, Grant J. An unusual gall-bladder polyp--site of metastatic renal cell carcinoma: a case report. Cases J. 2009;2:172-. https://doi.org/10.1186/1757-1626-2-172
39. Pierce DP, Dahmen AS, Hernandez DJ. Synchronous Metastatic Clear Cell Renal Cell Carcinoma to the Gallbladder With Metachronous Contralateral Recurrence. Cureus. 2021;13:e15007-e. https://doi.org/10.7759/cureus.15007
40. Robledo AB, Millet SB, Orbis Castellanos JF, Montalvá Orón EM, Salom Fuster JV, De Juan Burgueño M. Metastasis of the gallbladder in clear cell renal carcinoma. Oncol Lett. 2012;3:1136-8. https://doi.org/10.3892/ol.2012.616
41. Saito Y, Okuda H, Yoshida M, Okimasa S, Fukuda T, Yano M, et al. Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report. J Med Case Rep. 2018;12:162-. https://doi.org/10.1186/s13256-018-1569-3
42. Satoh H, Iyama A, Hidaka K, Nakashiro H, Harada S, Hisatsugu T. Metastatic carcinoma of the gallbladder from renal cancer presenting as intraluminal polypoid mass. Dig Dis Sci. 1991;36:520-3. https://doi.org/10.1007/BF01298886
43. Shoji S, Mukai M, Yazawa N, Sekido Y, Nagata Y, Uchida T, Terachi T. Metastasis to gallbladder and adrenal gland of renal cell carcinoma. Oncol Lett. 2010;1:507-9. https://doi.org/10.3892/ol_00000089
44. Takagi K, Kawase K, Minoshima K, Yamaha M, Maekawa Y, Yokoi S, et al. Gallbladder metastasis from renal cell carcinoma: A case report and literature review. Urol Case Rep. 2019;23:69-71. https://doi.org/10.1016/j.eucr.2019.01.006
45. Takenaka M, Okabe Y, Kudo M. Hemorrhage from metastasis of a 5-mm renal cell carcinoma lesion to the gallbladder detected by contrast-enhanced endoscopic ultrasonography. Dig Liver Dis. 2019;51:743. https://doi.org/10.1016/j.dld.2018.11.010
46. Ueda I, Aoki T, Oki H, Takahashi H, Hayashida Y, Minagawa N, et al. Gallbladder Metastasis from Renal Cell Carcinoma: A Case Report with Review of the Literature. Magn Reson Med Sci. 2015;14:133-8. https://doi.org/10.2463/mrms.2013-0130
47. Yin J, Li B, Zheng M. Ipsilateral Synchronous Papillary and Clear Cell Renal Cell Carcinoma: a Case Report and Literature Review. Research Square Platform LLC; 2021. https://doi.org/10.21203/rs.3.rs-141433/v1
48. Zevallos Quiroz JC, Lizarazu Pérez A, Guisasola Gorrochategui E, Medrano Gomez MA, Jiménez Agüero R. Gallbladder Metastasis From Renal Cell Carcinoma, an Extremely Rare Neoplastic Dissemination Location. Cir Esp (Engl Ed). 2014;92:295 https://doi.org/10.1016/j.ciresp.2012.02.017
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| Files | ||
| Issue | Vol 7 No 4 (2024) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/ajs.v7i4.17469 | |
| Keywords | ||
| Renal Cell Carcinoma; Gallbladder Metastasis; Metachronous Metastasis; Immunohistochemistry; PAX8 Negativity; Cholecystectomy; Case Report | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sargazi Moghaddam N, Germizadeh B, Farahangiz M, Dehghani S, Mojallal M, Houshdaran F. Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review. AJS. 2025;7(4):137-148.
