Gallbladder and Rectal Synchronous Adenocarcinoma: Case Report

Abstract

Synchronous tumors in both the rectum and the gallbladder are extremely rare. This study reports a case of gallbladder and rectal synchronic tumors, histopathologically confirmed, and discusses the therapeutic strategies in managing multiple primary cancers. Patient files from the Patient Files and Statistical Department of the University Hospital João de Barros Barreto and review of English literature were analyzed. Data from a case of a 69-year-old female patient with compressive vaginal and anal pain, constipation, and hematochezia were reviewed. Rectal touch evidenced a vegetating and infiltrative tumoral lesion, and colonoscopy demonstrated an elevated, vegetating, and infiltrative lesion. The histopathological analyses confirmed a moderately differentiated adenocarcinoma. A preoperative computer tomography scan was negative for metastasis investigation and, as an incidental finding, demonstrated cholelithiasis. The histological evaluation of the surgical specimens demonstrated rectal cancer, gallbladder cancer, and also hepatic metastasis. Due to the presence of hepatic and rectal cancer metastases, the standard management of the gallbladder cancer was modified according to the general concept that radical treatment of synchronous tumors should be reserved to situations were all tumors can be treated curatively or can improve life expectancy. Primary gallbladder and rectal synchronous neoplasms are rare and the treatment must be specific to each tumor, following the guidelines of each cancer whenever feasible. In case of metastasis or advanced stages of the disease, the treatment strategies must consider the most advanced tumor and/or the worst prognosis, and aggressive procedures must be avoided when it is not possible to radically treat every synchronous tumor.