背景:偶发胆囊癌是指在胆囊切除术期间或之后发现的胆囊癌。腹腔镜胆囊切除术(LC)后的晚期端口部位转移(PSM)很少见,发生率为10.3%。
方法:我们报告一例58岁的男性,表现为腹壁肿块疼痛6周。他有症状性胆石症的LC病史,8年前
方法:组织病理学检查显示腹壁肿块的转移性腺癌阳性结果。此外,正电子发射断层扫描(PET)显示胆囊床中少量的氟脱氧葡萄糖(FDG)摄取,这是高度可疑的恶性肿瘤。
方法:由于胆囊床上的摄取,决定进行手术,并向先前的端口部位转移。此外,在董事会会议上,根据在全转移检查中发现的结果,由于恶性肿瘤的不确定性,我们就进行远端胰腺切除术和脾切除术达成了协议.诊断性腹腔镜检查,然后进行中线剖腹手术。行根治性完整胆囊切除术伴淋巴结清扫术。随后完整切除前腹壁。然后进行胰体切除术和脾切除术。
结果:病理诊断显示转移性/侵袭性,中分化腺癌,切除的端口部位肿块后表面切缘阳性。阳性边缘需要进一步的放化疗,随后进行辅助化疗,直至发现肺转移。在这之后,患者计划接受姑息性化疗.
结论:PSM的存在通常与腹膜转移有关。出于这个原因,建议评估患者是否有转移。
BACKGROUND: Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%.
METHODS: We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior.
METHODS: Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy.
METHODS: Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed.
RESULTS: Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy.
CONCLUSIONS: Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.