title: Bilateral synchronous breast carcinomas followed by a metastasis to the gallbladder: a case report.
abstract: BACKGROUND
  Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare.
  
  
  METHODS
  A 59-year-old woman presented with bilateral synchronous breast lesions. A palpable, retroareolar solid lesion of diameter equal to 5 cm was present in the right breast, and a newly developed, non-palpable lesion with microcalcifications (diameter equal to 0.7 cm) was present in the upper outer quadrant of the left breast. Modified radical mastectomy was performed on the right breast and lumpectomy after hook-wire localization was performed on the left breast, combined with lymph node dissection in both sides. The pathological examination revealed invasive lobular carcinoma grade II in the right breast and invasive ductal carcinoma grade I in the left breast. Chemotherapy, radiation therapy, trastuzumab and letrozole were appropriately administered. At her 18-month follow-up, the patient was free of symptoms; the imaging tests (chest CT, abdominal U/S, bone scan), biochemical tests, blood cell count and tumor markers were also normal. At the 20th month after surgery however, the patient developed symptoms of cholecystitis and underwent cholecystectomy. The histopathological examination revealed metastasis of the lobular carcinoma to the gallbladder.
  
  
  CONCLUSIONS
  This extremely rare case confirms on a single patient the results of large series having demonstrated the preferential metastasis of lobular breast cancer to the gallbladder. Symptoms of cholecystitis should not be neglected in such patients, as they might indicate metastasis to the gallbladder.
authors.affiliation: Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Greece. florazagouri@yahoo.co.uk
authors.forename: Flora
authors.initials: F
authors.lastname: Zagouri
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Dimitra
authors.initials: D
authors.lastname: Koulocheri
authors.forename: Afroditi
authors.initials: A
authors.lastname: Nonni
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Bousiotou
authors.forename: Philip
authors.initials: P
authors.lastname: Domeyer
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Michalopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dardamanis
authors.forename: Manousos M
authors.initials: MM
authors.lastname: Konstadoulakis
authors.forename: George C
authors.initials: GC
authors.lastname: Zografos
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002763:Cholecystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D016896:Treatment Outcome