title: Metastatic carcinoma of the gallbladder mimicking an advanced cervical carcinoma.
abstract: BACKGROUND
  Metastasis to the uterine cervix from a non-gynecologic neoplasm is extremely rare. To our knowledge, only three cases of primary carcinoma of the gallbladder with metastasis to the cervix have been previously reported. We report a case of metastatic gallbladder carcinoma mimicking a stage IIIB cervical carcinoma.
  
  
  METHODS
  A 74 year-old woman presented with pain in her left lumbar area radiating to her left flank. On physical examination, a 6 cm cervical tumor involving the left parametrium was noted. A computed tomography (CT) scan of the pelvis showed left-sided hydronephrosis and hydroureter with distal ureteral obstruction. A Pap smear revealed adenocarcinoma, and a biopsy of the endocervical canal was consistent with poorly differentiated adenocarcinoma. The patient was referred to a tertiary care center. On review of the biopsy after referral, the carcinoma was felt to be unusual for an endocervical primary and immunohistochemical stains were ordered. The carcinoma was positive for cytokeratin 7, had only focal cytoplasmic staining for p16, and was negative for carcinoembryonic antigen and cytokeratin 20. Upon presentation, the patient complained of new onset of shortness of breath and cough. A chest CT revealed multiple lesions in both lungs suggestive of metastatic disease, and an abdominal CT revealed a gallbladder tumor with extension into the liver. The patient underwent a CT-guided biopsy of one of the lung lesions and the pathologic findings were consistent with metastatic adenocarcinoma. The patient was diagnosed with stage IVB primary gallbladder adenocarcinoma and was treated with capecitabine, but her condition deteriorated rapidly and she died 5 months later.
  
  
  CONCLUSIONS
  In patients with an atypical presentation for cervical adenocarcinoma, it is important to consider a metastatic tumor in the differential diagnosis and to perform a thorough work-up for metastatic disease before initiating therapy.
authors.affiliation: Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic, Universitat de Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Martínez-Román
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Michael T
authors.initials: MT
authors.lastname: Deavers
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000556:secondary*