Abstract
A 62-year-old woman came into our emergency room complaining of convulsions of the left extremity. A contrast-enhanced computed tomography (CT) scan of the brain revealed a 3-cm heterogeneous right parietal lobe mass. Using brain tumor excision surgery, we diagnosed her brain tumor as metastatic adenocarcinoma. A CT scan, echogram, magnetic resonance imaging (MRI) of the abdomen revealed irregular thickening of the gallbladder wall, and an FDG-PET demonstrated that the gallbladder wall had a high-uptake structure. A specimen obtained by percutaneous transhepatic gallbladder fine needle aspiration included cells strongly suspected of adenocarcinoma. No other primary site was detected, so we finally diagnosed her illness as an adenocarcinoma of the gallbladder with solitary brain metastasis. A treatment course of tegafur, gimeracil, and oteracil potassium (S1) was started. After several months, brain tumor recurrence and a primary tumor invasion of the liver were observed. A convulsion attack also occurred. Though palliative radiation therapy to the brain was started, she died 14 months after her first admission. In the gallbladder cancer, it is very unusual to show a sign derived from brain metastasis as an initial manifestation. We report this rare case with a review of the literature.
