Gallbladder cancer with tumor thrombus in the superior vena cava.
BACKGROUND
Gastrointestinal cancers, especially pancreatobiliary cancers, are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage, especially of the abdomen and lower limbs. This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava (SVC) with resultant SVC obstruction, while on gefitinib-based anti-epidermal growth factor receptor (EGFR) therapy.


METHODS
A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy. She had disease recurrence and received systemic chemotherapy followed by gefitinib-based anti-EGFR therapy. Subsequently, while on gefitinib-based therapy, she presented with clinical signs and symptoms suggestive of SVC thrombosis.


RESULTS
A whole body PET scan revealed a metabolically active tumor thrombus in the SVC, besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen. She was treated with anti-thrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief. She continues to survive on the day of writing this report.


CONCLUSIONS
This rare complication, though theoretically possible, is unreported because of the short overall survival of advanced gallbladder cancer patients. This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients, we may come across such cases more frequently in the future.
Batra
Sandeep
S
Department of Medical Oncology, Rajiv Gandhi Cancer Hospital, Sector 5, Rohini, New Delhi, India. sandeepriya2000@yahoo.com
Doval
Dinesh Chandra
DC
Batra
Ullas
U
Suresh
Pandalanghat
P
Dhiman
Amit
A
Talwar
Vineet
V
D000230:Adenocarcinoma / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D000970:Antineoplastic Agents / Q000627:therapeutic use; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D000077156:Gefitinib; D006801:Humans; D033162:Incidental Findings; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D049268:Positron-Emission Tomography; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D013479:Superior Vena Cava Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000473:pathology*
D000970:Antineoplastic Agents; D005343:Fibrinolytic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib