General Discussion: FULL PATIENT HISTORY:
61-year-old gentleman, who, approximately one month prior to his presentation, was diagnosed with non-small cell lung cancer with metastases to the right thyroid, gallbladder, duodenum, and distal small bowel. He additionally had a past medical history of schizophrenia.
At admission, he had a history of two days of worsening abdominal pain, nausea and vomiting, and constipation.
A chest X-ray showed a large left upper lobe mass which was encasing the lingular bronchus, pulmonary artery, pulmonary vein. A fine-needle aspiration was consistent with non-small cell lung cancer. Abdominal sonography showed a gallbladder filled with solid, echogenic material, most suggestive of lung cancer metastatic to the gallbladder in the background of adenomyomatosis versus a primary gallbladder malignancy. Neck sonography showed a solid, heterogeneous lesion within the inferior portion of the right lobe of the thyroid which had features suspicious for malignancy.
DISCUSSION:
Although non-small cell lung cancer is known for its potency to spread to almost any organ of the body, metastasis to the gallbladder with significant clinical manifestation is rarely reported in the literature.
An FDG avid gall bladder most likely represents an inflammatory etiology like CBD obstruction, TB or cholecystitis. It is also seen in rare neoplastic settings like a primary gall bladder cancer and metastases. Adenomyomatosis occasionally shows FDG avidity.
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