Rare case of gallbladder cancer presenting with meta- stasis to bone and brain in an African American male discovered by F18-FDG PET/CT

The most common site of metastasis in gallbladder cancer is the liver. To our knowledge, there are no reports in the literature of gallbladder cancer metastasizing to both the brain parenchyma and the bone.  There are only 5 prior reports of gallbladder cancer metastasis to the bone in the English Language literature. Likewise, gallbladder neoplasm metastasizing into the brain parenchyma is extremely rare. We present a rare case of gallbladder cancer presenting with metastases to both the brain parenchyma and the bone in a 71 year old African American male. This patient had early bone metastasis evidenced by hypermetabolic lesions on FDG PET/CT imaging, without density abnormalities of the bone tissue. Gastrointestinal (GI) tumors are commonly detected by CT but for metastasis, F18-FDG PET/CT has higher sensitivity and higher positive predictive value than CT. Since at the initial presentation, most patients suffering from gallbladder cancer tend to have metastatic disease, we raise a question as to whether F18-FDG PET/CT scans should be included in the routine work-up protocol.