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Tuesday, July 22, 2014
relative diagnosed with gallbladder ca approx. 1.5 yrs ago. gallbladder removed and whipple procedure done. did have a couple positive lymph nodes. no sign of recurrance until recent ct scan. it revealed a larger subcarinal node(2.8-was 0nly 0.8 6 mos ago), and also revealed 19mm mass like infiltrate in right upper lobe with fibrotic changes and does appear nodular. no other lymph nodes are enlarged. 6 mos ago, a ct scan revealed a few nodules and some scarring in bases of lungs, but nothing like this. gallbladder ca dr said it is rare for gallbl. ca to first show recurrance in the lung, but always a possibility. what should be the next step?
Thank you for your question. Yes it is rare for a malignancy of the gallbladder to metastasize to the lung. I would be more concerned about a primary process in the lung. The appearance of a nodular infiltrate and lymphadenopathy should be carefully investigated to rule out either malignancy or infection as the most common causes. The evaluation may include either bronchoscopy, CT guided biopsy or if infection is likely, treatment with antibiotics and repeat imaging to ensure resolution. A careful review of the history, exam and imaging should guide the workup.
Patrick Nana-Sinkam, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University