title: Skeletal metastasis in gallbladder cancer from a high-volume tertiary care center of north India: a series of rare occurrence.
abstract: OBJECTIVE
  Gallbladder carcinoma is usually characterized by late diagnosis and poor prognosis. Skeletal metastases in gallbladder cancer have been rarely reported in literature. In this study, we evaluated the incidence of skeletal metastasis in gallbladder cancer at our high-volume center and their clinical presentation, radiological imaging, treatment received, outcome, and survival.
  
  
  METHODS
  Records of all gallbladder carcinoma patients registered in our department from October 2007-October 2012 were retrospectively reviewed to identify gallbladder cancer patients with skeletal metastasis and their data was collected and analyzed.
  
  
  RESULTS
  Out of 340 cases of gallbladder carcinoma, 189 (55.58 %) were having stage IV disease. Of these, seven (2.1 %) patients had cytologically proven skeletal metastasis. All seven patients had advanced loco-regional abdominal disease with coexistent liver metastasis. Presenting symptoms were predominantly weight loss and back pain with markedly elevated serum alkaline phosphatase (median = 1231 IU/ml). Dorsolumbar vertebral metastasis was the most common site of skeletal metastasis in our series (5/7), followed by pelvic bone (2/7) while skull and sternal metastasis were present in one patient each. All these patients had short median survival (median = 30 days, range = 15-60 days).
  
  
  CONCLUSIONS
  Incidence of skeletal metastasis in gallbladder cancer is very low (2.1 %). Axial skeleton was the most common site of bone metastasis. Gallbladder cancer with skeletal metastasis portends poor prognosis with rapidly fatal course.
authors.affiliation: Department of Surgical Oncology, King George's Medical University, Lucknow, 226003, India, sameerdr79@gmail.com.
authors.forename: Gupta
authors.initials: G
authors.lastname: Sameer
authors.forename: Akhtar
authors.initials: A
authors.lastname: Naseem
authors.forename: Kumar
authors.initials: K
authors.lastname: Vijay
authors.forename: Misra
authors.initials: M
authors.lastname: Sanjeev
authors.forename: Jain
authors.initials: J
authors.lastname: Jaswant
authors.forename: Ananthanarayanan Sindhu
authors.initials: AS
authors.lastname: Vadakkanchery
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011859:Radiography; D062606:Tertiary Care Centers / Q000706:statistics & numerical data