2007 Volume 40 Issue 5 Pages 576-581
A 54-year-old man with untreated cholelithiasis seen for dizziness was found to be markedly anemiae, and further examinations indicated advanced gastric cancer. Abdominal echography and computed tomography indicated gallstones, and the gallbladder wall could not be evaluated due to severe atrophy. Distal gastrectomy, regional lymphadenectomy and cholecystectomy were conducted under a preoperative diagnosis of gastric cancer and gallstones. The gastric lesion was a type 3 tumor of poorly differentiated adenocarcinoma with serosal penetration and lymphatic invasion. The gallbladder wall was markedly thickened, especially in the fundus and body, and metastasis of gastric cancer was diagnosed because the mucosal layer was spared and the site at which tumor cell infiltration was severest was stromal. The final gastric cancer stage was T3, N2, H0, P0, CY0, M1, Stage IV. Although bile leakage was prolonged after surgery, the patient was discharged on postoperative day 88. The patient died 5 months after surgery due to obstructive jaundice and carcinomatous pleuritis. The mechanism of gallbladder metastasis was considered the lymphogenous pathway. Gallbladder metastasis from gastric cancer is uncommon, and association with gallstones is very rare.
