Postmenopausal bleeding and vaginal nodules as the first presenting sign of adenocarcinoma of the gallbladder

Vaginal submucosal nodules were observed in a 67-year-old woman, with ultrasonographic features of an advanced uterine neoplasm. On biopsy, light microscopy suggested that the lesions might be metastatic foci from an extragenital cancer, with a prevalent tubular growth pattern. Parallel immunohistochemical reactions revealed a diffuse, strong CA 19-9 positivity in both the cell membrane and cytoplasm. Subsequently, high serum levels of such tumor marker were also found, and an extragenital cancer was suspected of pancreatic or biliary origin. A mass in the gallbladder fossa was then detected by computed tomography and a primary gallbladder adenocarcinoma was confirmed on ultrasound-guided biopsy.

Vaginal metastatic cancer; Gallbladder adenocarcinoma; Gallbladder genital metastases; CA 19-9-expressing neoplasm

[1] Schust D.J., Moore D.H., Baird D.B., Novotny D.B.: "Primary adenocarcinoma of the gallbladder presenting as primary gynecologic malignancy: a re-port of two cases". Obstet. Gynecol., 1994, 83, 831.

[2] Young R.H., Scully R.E.: "Metastatic tumors of the ovary". In Kurman R.J. (ed.) Blaustein's Pathology of the Female Genital Tract, New York, Springer-Verlag, 1063, 2002.

[3] Ono T., Komatsu M., Hoshino T., Ishii T., Fujii T., Oshima S. et al.: "Alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9-producing gallbladder cancer" J. Gastroenterol., 1996, 31, 742.

[4] Kijima H., Kashiwagi H., Dowaki S., Ohtani Y., Tobita K., Matsubayasi H. et al.: "Stromal sialyl Le(a) expression is correlated with vascular invasion of human gallbladder adenocarcinoma". Int. J. Oneal., 2000, 17, 55.

[5] Noshiro H., Chijiiwa K., Yamaguchi K., Shimizu S., Sugitani A., Tanaka M.: "Factors affecting surgical outcome for gallbladder carcinoma". Hepatogastroenterology, 2003, 50, 939.