title: Two cases of gallbladder metastasis from renal cell carcinoma and review of literature.
abstract: BACKGROUND
  Renal cell carcinoma accounts for 90% of renal neoplasms and metastatic disease is common. One third of newly diagnosed cases will have synchronous metastases at diagnosis and further 25-50 % will develop metachronous disease.
  
  
  METHODS
  This study presents two new cases of gallbladder metastasis from renal cell carcinoma (RCC) from our institution and reviews the published literature. The final cohort included 52 evaluable patients. M/F ratio was 2:1 and median age was 62.5 years. Most patients were diagnosed incidentally after follow-up or staging imaging for RCC. Of the patients with available histology, all except one were clear cell type (n = 39) and 92% were polypoid. Thirty-six patients demonstrated metachronous gallbladder metastasis with median disease-free interval (DFI) from nephrectomy of 4 years. The most frequent site of metastasis was the contralateral kidney (46.7%) followed by the pancreas and lung. The median disease-free interval (DFS) after cholecystectomy was 37 months. Three- and five-year OS rates were 74 and 62%, respectively. Age younger than 45 years (p = 0.008) and DFI <24 months (p = 0.049) were associated with decreased OS.
  
  
  CONCLUSIONS
  RCC metastasis to the gallbladder is associated with an unusual pattern of concomitant metastasis. Symptoms are not common. Simple cholecystectomy is associated with increased OS and nil local or port site recurrence. Young age and short DFI are associated with decreased OS.
authors.affiliation: Academic Surgery Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. mafaldajardim@hotmail.com.|Surgery Department, The London Clinic, 116 Harley Street, London, W1G 7JL, UK. mafaldajardim@hotmail.com.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Costa Neves
authors.affiliation: Academic Surgery Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.affiliation: Surgery Department, The London Clinic, 116 Harley Street, London, W1G 7JL, UK.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.affiliation: Pathology Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hazell
authors.affiliation: Pathology Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wotherspoon
authors.affiliation: Urology Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Gore
authors.affiliation: Academic Surgery Department, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.|Surgery Department, The London Clinic, 116 Harley Street, London, W1G 7JL, UK.|Department of Surgery and Cancer-Faculty of Medicine, Imperial College London, London, W2 1PG, UK.
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: Cancer; Clear cell metastatic renal cell carcinoma; Gallbladder; Kidney neoplasms