title: Isolated metastasis to the gallbladder from hepatocellular carcinoma.
abstract: OBJECTIVE
  Metastasis to gallbladder (GB) from hepatocellular carcinoma (HCC) is rare, and it is difficult to determine indications for surgery. We report eight cases of synchronous isolated GB metastasis, and analyze their features retrospectively.
  
  
  METHODS
  Among 439 HCC patients who underwent hepatectomy from 1998 to 2008 at our institution, 393 (89.5%) underwent concurrent cholecystectomy.
  
  
  RESULTS
  Among them, eight (1.8%) had GB metastasis without other distant metastases. None of these cases showed evidence of direct invasion. All cases had advanced portal vein thrombus (PVTT) and their main tumor located near the GB bed. Five cases had apparent tumor mass in the GB wall, and the other three cases had only tumor thrombus in the GB veins. Six cases were treated postoperatively with local infusion therapy with interferon, and three of them showed long-term survival.
  
  
  CONCLUSIONS
  Our eight cases of GB metastasis from HCC were closely related to PVTT. Surgical resection and multimodal treatment would be necessary for long-term survival in cases with isolated GB metastasis.
authors.affiliation: Department of Surgery Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, 565-0871, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakami
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanemura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Wakasa
authors.initials: W
authors.lastname: Kennichi
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano