Six year disease free survival after liver transplantation in a patient with T3 gallbladder carcinoma: case presentation

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Six year disease free survival after liver transplantation in a patient with T3 gallbladder carcinoma: case presentation and review of the literature Jorge Ortiz*1, David Reich2, Hoon Bae Joon3, Oscar Martinez2 and Cosme Manzarbeitia2 Address: 1Texas Transplant Institute, 8201 Ewing Halsell #280, SanAntonio, Texas 78229, USA, 2Albert Einstein Medical Center, 5501 Old York Road, Center forLiver Diseases, Philadelphia, PA 19141, USA and 3University of Kentucky, 800 Rose Street, Division ofTransplant, Lexington, KY 40536, USA Email: Jorge Ortiz* - [email protected]; David Reich - [email protected]; Hoon Bae Joon - [email protected]; Oscar Martinez - [email protected]; Cosme Manzarbeitia - [email protected] * Corresponding author

Published: 14 July 2006 World Journal of Surgical Oncology 2006, 4:45

doi:10.1186/1477-7819-4-45

Received: 13 December 2005 Accepted: 14 July 2006

This article is available from: http://www.wjso.com/content/4/1/45 © 2006 Ortiz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background: The incidence of gallbladder carcinoma in cirrhotics is unknown. Known risk factors are primary sclerosing cholangitis and polypoid masses. Case presentation: A sixty year old with primary sclerosing cholangitis, cirrhosis, and gallbladder polyps underwent liver transplantation. A polypoid lesion measuring 1.5 × 0.5 cm was found on the fundus of the gallbladder. Histological examination revealed moderately differentiated adenocarcinoma with full thickness penetration of the gallbladder encroaching liver parenchyma. Angiolymphatic invasion was noted. The lymph nodes, the cystic duct and the common duct were free of tumor (T3N0M0). Extensive evaluation did not demonstrate metastasis. No chemotherapy was given. He is currently six years post procedure and free of disease. Conclusion: "Incidentally" discovered stage IIA gallbladder carcinoma may not negatively affect long term survival after liver transplantation.

Background Between 6000 and 7000 cases of gallbladder carcinoma are diagnosed yearly in the United States. Advanced gallbladder carcinoma (GBC) usually portends an extremely grave prognosis [1]. Recent reports in the literature have demonstrated improved results after aggressive surgical resection for stage II–IV lesions [2]. Although there are sporadic reports of incidental gallbladder carcinoma found after liver transplantation, no consensus exists on the proper treatment for those patients found to have gallbladder carcinoma with cirrhosis.

Major risk factors for the development of GBC include polypoid lesions and sclerosing cholangitis (PSC). Larger polyps, especially in the setting of PSC (with or without cirrhosis) have a greater than 50% chance of harboring malignancy [3]. Primary scle