Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review

Nasibeh Sargazi Moghaddam; Bita Germizadeh; Mahtab Farahangi; Sima Dehghani; Mehra Mojallal; Farzad Houshdaran

doi:10.18502/ajs.v7i4.17469

Nasibeh Sargazi Moghaddam Graduated, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Bita Germizadeh Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran
Mahtab Farahangi Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
Sima Dehghani Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
Mehra Mojallal Pathology Laboratory, Dena Hospital, Shiraz 71345, Iran
Farzad Houshdaran Surgery Ward, Dena Hospital, Shiraz 71345, Iran

DOI: https://doi.org/10.18502/ajs.v7i4.17469

Keywords: Renal cell carcinoma, Gallbladder metastasis, Metachronous metastasis, Immunohistochemistry, PAX8 negativity, Cholecystectomy, Case report

Abstract

Background: Renal cell carcinoma (RCC) is a malignancy known for its high metastatic potential, commonly spreading to the lungs, bones, brain, liver, and adrenal glands. Gallbladder metastasis from RCC is exceedingly rare and poses significant diagnostic challenges due to its asymptomatic nature and nonspecific imaging findings.

Case Presentation: We report the case of a 58-year-old Persian man with a history of clear cell RCC treated with left radical nephrectomy 34 months prior. The patient presented with right upper quadrant abdominal pain. Imaging studies, including contrast-enhanced computed tomography and ultrasound, revealed two hypervascular polypoid lesions within the gallbladder. An open cholecystectomy was performed due to the suspicion of malignancy. Histopathological examination confirmed metastatic clear cell RCC invading the gallbladder wall. Notably, immunohistochemical analysis showed tumor cells positive for cytokeratin 19, alpha-methylacyl-CoA racemase, and vimentin, but negative for paired box gene 8, cytokeratin 7, cytokeratin 20, and cluster of differentiation 117 (C-Kit). The absence of paired box gene 8 expression is atypical for RCC metastasis and posed a diagnostic challenge. The patient had an uneventful postoperative recovery but unfortunately passed away two months later due to a cerebrovascular accident unrelated to his oncological condition.

Conclusions: This case underscores the importance of considering gallbladder metastasis in the differential diagnosis for patients with a history of RCC presenting with gallbladder lesions. The atypical immunohistochemical profile observed expands the known spectrum of metastatic RCC presentations and highlights the necessity for comprehensive diagnostic evaluation. Surgical intervention through cholecystectomy can lead to favorable outcomes and should be considered in similar cases.