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Intramuscular Metastasis of Gallbladder Carcinoma

Chinmay Jani

Introduction: Gallbladder cancer is a highly fatal malignancy. Even though it is a rare malignancy, it is the most common biliary tract malignancy in USA. Majority of the patients are asymptomatic and among symptomatic patients, the most common complains include pain, anorexia, nausea or vomiting. Patients with GBC may also present with obstructive jaundice, either from direct invasion of the biliary tree or from metastatic liver diseases. Gall bladder carcinoma mainly metastasizes to liver, intra-abdominal LNs and biliary tract. Intramuscular and subcutaneous manifestations are very rare from gallbladder carcinoma. In this article we present a rare case of Intramuscular metastasis of gallbladder carcinoma in an African American lady with no other history of gallbladder disease. Case narration: 55 year old African American lady with history of poly-substance abuse disorder presented to Boston Medical Centre with 2 months of progressive Right Upper Quadrant abdominal pain. She had CT scan showing 6.3 cm mass in gallbladder invading into the liver which on biopsy was consistent with adenocarcinoma of gallbladder. She presented again in the Emergency Department with a new 3 x 3 cm lump in her left arm and 5 x 5 cm lump in her left thigh. A CT Scan of the thigh mass showed an extensive lesion in her left thigh muscles again which on USG guided biopsy confirmed intramuscular metastasis with IHC positive for CK7, AE1:3 and CAM5.2 consistent with metastatic gallbladder adenocarcinoma.  Conclusion: Although rare, intramuscular lesions should raise suspicion of metastatic disease in the gall bladder carcinoma patients. In our case, patient reported two new rapidly growing lesions consistent with rapid progression of disease. Palliative radiation therapy should be considered in patients with severe pain associated with intramuscular metastasis. Intramuscular metastasis is usually associated with poorer prognosis