Sir,
Gall bladder carcinoma is common in North India, particularly in females. Cutaneous metastasis from gall bladder carcinoma is rare. We report one more such case where the diagnosis was established on fine needle aspiration cytology (FNAC). A 40-year-old female presented with multiple cutaneous nodules over scalp for 2 months which were progressively increasing in size. Largest scalp nodule measured 3× 3 cm in size, it was hard in consistency and fixed to underline structure. On examination, she had a lump in right hypochondrium and jaundice. The hemogram was unremarkable except serum billirubin was 3.5 mg/ dL and serum alkaline phosphatase was 1780 IU. FNAC of these scalp nodules showed a metastatic adenocarcinoma. The malignant epithelial cells were arranged in sheets, clusters, acini and papillary pattern. Individual cells were pleomorphic having round to oval nuclei with mild to moderate cytoplasm, increased Nuclear cytoplasmic ratio and occasional bizarre cells [Figure 1]. Patient was investigated for a primary neoplasm. Ultrasound and computed tomography (CT) scan of the abdomen revealed a growth in gall bladder fossa which was infiltrating into the liver along with enlarged lymph nodes. Ultrasonographic (USG)-guided FNAC smears from the gall bladder showed features of adenocarcinoma. On the basis of clinical, radiological and cytomorphological features, she was diagnosed as a case of adenocarcinoma gall bladder with cutaneous metastases. Cutaneous metastasis from internal organ carcinomas are relatively rare.[1,2] and may present in three different settings: patients with a known malignancy developing cutaneous metastases, patients presenting with cutaneous metastases along with obvious malignancy and some presenting with cutaneous metastases without any obvious malignancy. Only nine cases of cutaneous metastases from gall bladder carcinoma have been reported.[1] Primary carcinoma gallbladder spread by direct extension and metastasis. The liver is most commonly affected organ by direct extension, with an incidence ranging from 60 to 90%, while regional lymph nodes are involved in about 60% of cases. Extra-abdominal metastasis is very rare and spread by vascular dissemination and homing of tumor cells. Lung is the most common site and other rare sites from carcinoma gall bladder are central nervous system,[3] orbit,[4] breast,[5] thigh, upper arm, neck and back. Metastasis on the scalp is even rarer and an unusual metastatic pattern of carcinoma gall bladder. Considering the high incidence of gall bladder cancer in North India, possibility of gall bladder metastases to skin should also be kept in mind while searching for the primary. FNAC provides a quick and confident morphological diagnosis.
Figure 1.
FNAC from scalp nodule showing acini, and clusters of malignant cells (Giemsa, × 400)
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