Teaching Case

Female patient that presented to our emergency department with lower abdominal pain, haematuria and vaginal discharge. During evaluation, she was forwarded to our department and underwent a pelvic ultrasound. She had a history of adenocarcinoma of the gallbladder and was subject to cholecystectomy in 2007.

During evaluation, the patient underwent a pelvic ultrasound which demonstrated endometrial thickening and irregularity, as well as an anechoic/hypoechoic lesion, which seemed to cause distention of the endometrial cavity. Due to the high suspicion of these findings, she was admitted to the OB/GYN department for further evaluation. During her stay, physical examination revealed supra-clavicular adenopathies and on routine chest radiography there was also bilateral pleural effusion and nodular opacities dispersed throughout both lungs. The patient underwent a biopsy of the endometrial lesion as well CT of the thorax, abdomen and pelvis. The CT findings were suggestive of disseminated metastatic disease, without an apparent primary origin. The biopsy results where compatible with adenocarcinoma of the gallbladder. The endometrial lesion was further characterized with pelvic MR and the course of treatment decided by a multidisciplinary team.

Metastatic disease to the uterine cervix is an incredibly rare occurrence. According to recent literature there are only four cases described of metastatic adenocarcinoma of the gallbladder mimicking a cervical carcinoma [1]. Most of the non-gynaecological metastases to the cervix are secondary to gastric or mammary neoplasms [1, 2].
This rare occurrence often poses a diagnostic dilemma, either for the clinician or the pathologist. In the midst of metastatic disease, involvement of the cervix may be seen and is actually very straightforward. On the other hand, cervical lesions may be the presenting form of a non-gynaecologic carcinoma, making it difficult to distinguish between a primary and secondary neoplasm, which in turn dictates prognosis and allows for proper treatment.
In this particular case, the imaging modalities employed were important for adequate characterization and staging of the disease, which in turn allowed for adequate treatment. As mentioned earlier, this patient underwent a biopsy. After careful evaluation of the patient's previous examinations, the high positivity to CK7 on immunohistochemical examination [3] and the microscopic pattern compatible with moderately differentiated adenocarcinoma, this patient was diagnosed with secondary involvement of the uterine cervix by a metastatic gallbladder carcinoma.
Due to the advanced stage of the disease, and after a multidisciplinary meeting, it was decided that this patient was only eligible for conservative medical treatment.