A case of gallbladder signet-ring cell carcinoma with multiple skeletal muscle metastases

Abstract

During regular hospital visits for autoimmune pancreatitis, a 74-year-old man visited the hospital because of his swelling and spontaneous pain in the right inguinal region. Computed tomography showed multiple subcutaneous and intramuscular masses in the neck, abdomen, and groin, thickening of the gallbladder and bile duct walls, and enlarged intraperitoneal lymph nodes. ERCP showed stenosis of the hilar bile duct and distal bile duct, and EUS revealed a thickening of the gallbladder and bile duct walls. EUS-FNA of the hepatoduodenal lymph nodes showed signet-ring cell carcinoma, and a biopsy of the intramuscular mass of the thigh also showed signet-ring cell carcinoma. Skeletal muscle metastasis from biliary signet-ring cell carcinoma was suspected. Five courses of combination therapy with gemcitabine, cisplatin, and S-1 were ineffective, and the patient died 7 months after the diagnosis. An autopsy revealed the presence of primary signet-ring cell carcinoma originating from the gallbladder.