An Unusual Reach of Gallbladder Cancer: A Case Report

Introduction: Gallbladder cancer (GBC) is one of the common malignancies of the biliary tree but due to its non-specific presentations it always presents in advance stage. Poor prognoses of GBC are due to early metastasis into the Liver bed and the regional lymph nodes (LNs). Extra-abdominal metastasis is rare in GBC and here we are presenting a case of gallbladder cancer with bilateral inguinal lymph node metastasis.

Case Report: A 69-year-old male presented with complains of yellowish discoloration of the eye and urine for 3 months and swelling over the left groin, fever, pain abdomen and loss of appetite for 1 week. Systemic examination revealed gallbladder mass and bilateral inguinal lymphadenopathy. CT scan and FNAC confirm carcinoma gallbladder with metastatic adenocarcinoma.

Discussion: Carcinoma Gallbladder is the most common biliary tree malignancy with as high as 80-95% incidence. The cystic and pericholedochal LNs are the first sites to get involved in the lymphatic spread [1]. There are three major pathways of lymphatic's spread for CGB which ultimately drains into aortocaval LNs. Lymphatic channel blockage by tumor cells leads to the flow of the lymph into retrograde fashion into some unusual sites. Similarly in our case also retrograde flow must have involved the paraaortic LNs from where it must have spread into the pelvic and bilateral Inguinal LNs.

Conclusion: To conclude, bilateral inguinal metastasis is possible in CGB due to retrograde lymph flow due to lymphatic obstruction.