title: A case report of symptomatic gallbladder disease in the setting of peritoneal carcinomatosis originating from invasive lobular carcinoma of the breast.
abstract: BACKGROUND
  Invasive lobular carcinoma is the second most common type of breast cancer, responsible for 5-15 percent of all cases. Peritoneal carcinomatosis secondary to breast cancer is a rare event, frequently resulting in morbidity and mortality. Symptomatic gallbladder disease in the setting of peritoneal carcinomatosis originating from invasive lobular carcinoma of the breast is a very rare event and is not well covered in literature.
  
  
  METHODS
  A 44year old female patient previously diagnosed with stage IV invasive lobular carcinoma of the left breast with widespread systemic metastases and peritoneal carcinomatosis presented with a three week history of right upper quadrant pain trigged by food intake only, greatly diminishing her quality of life. She had spent almost a year in a progression free disease status but was now suffering from debilitating symptomatic gallbladder disease. Despite the extent of her peritoneal carcinomatosis, she elected to undergo a laparoscopic cholecystectomy.
  
  
  CONCLUSIONS
  We are presenting a rare case of symptomatic gallbladder disease in the setting of peritoneal carcinomatosis secondary to invasive lobular carcinoma. A major concern is tumor load within nearby portal structures. Even though laparoscopic cholecystectomy could be a viable option to treat the condition, it needs to be applied selectively and very cautiously in the respective patient population.
  
  
  CONCLUSIONS
  Symptomatic gallbladder disease in the setting of peritoneal carcinomatosis secondary to invasive lobular carcinoma is an uncommon presentation to surgeons. A diagnostic laparoscopy is the preferred initial evaluation. If deemed feasible, and if the surgeon has the required experience, a laparoscopic cholecystectomy can be undertaken selectively.
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX, 79106-1786, USA. Electronic address: david.g.brinkman@ttuhsc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Brinkman
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX, 79106-1786, USA. Electronic address: subhasis.misra@ttuhsc.edu.
authors.forename: Subhasis
authors.initials: S
authors.lastname: Misra
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX, 79106-1786, USA. Electronic address: nail.aydin@ttuhsc.edu.
authors.forename: Nail
authors.initials: N
authors.lastname: Aydin
keywords: Case report; Gallbladder disease; Invasive lobular breast; Peritoneal carcinomatosis