Synchronous dual malignancy: a rare case report of carcinoma breast with carcinoma gall bladder

Abstract

Incidence of multiple primary cancers is reported to be between 0.18% to 17.2% in various studies. Occurrence of breast and gall bladder malignancy as synchronous malignancy is very rare. We are reporting one of such rare case. Our patient, a 64 years old lady had a unique presentation. She underwent laparoscopic cholecystectomy for a clinical diagnosis of cholelithiasis. Histopathology turned out to be adenocarcinoma of the gall bladder (Stage II A). A clinical examination done at the time of presentation to our institute revealed suspicious thickening of the skin of the left breast and a subsequent tru-cut biopsy revealed infiltrating ductal carcinoma. Hormone receptor immunohistochemistry revealed oestrogen receptor (ER) negative progesterone receptor (PR) negative and Her2neu negative tumour. Further evaluation revealed a widespread metastatic disease. She was treated with palliative radiotherapy, chemotherapy and zolendronate. She had an aggressive clinical course and succumbed to her illness within four months after diagnosis of dual malignancy. There is a high incidence of gall bladder carcinoma along the Gangetic belt of Northern India. Presence of dual malignancy with gall bladder carcinoma as one primary in these geographic location needs to be further explored for sporadic environmental factors or other genetic alterations as possible causative factors.