Epigastric port site metastasis in an unknown primary: a rare case report

Abstract

OBJECTIVE: The advent of laparoscopic oncologic surgery has brought with it the peculiar issue of port-site metastasis (PSM). The most common source of primary site for PSM is from gall bladder, ovarian and pancreas in which some laparoscopic procedure has been done. PSM in a case of unknown primary is very rare. CASE REPORT: Herein we present a case of a 71-year-old female who had underwent laparoscopic cholecystectomy for cholelithiasis 2 years ago. There was no evidence of malignancy at that time. The patient presented after 2 years of the surgery with a mass at the epigastric port site region which was confirmed to be metastatic adenocarcinoma after histopathology and immunohistochemistry. The site of primary tumor could not be identified even after thorough investigations. RESULTS: The patient underwent wide local excision of the mass followed by adjuvant radiotherapy and chemotherapy for the same. To our knowledge this is the 3rd case reported in literature in which PSM has been found with primary unknown in post cholecystectomy for chronic cholecystitis. CONCLUSIONS: The treating physician should be aware that there is a possibility of development of PSM after a latency period ranging from a few months to years. The most common method to avoid PSM is to prevent intraoperative spillage.

Keywords

• port site metastasis
• unknown primary
• adenocarcinoma