Figure - available from: Case Reports in Surgery
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Right upper quadrant ultrasound showing 3.8 × 2.4 × 3.5 heterogeneous mass with small calcification emanating from the gallbladder fundus.
Source publication
Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced s...
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Gallbladder wall thickening, associated with features like perforation, fistula formation and invasion of adjacent organs, is often assumed to be malignant. Xanthogranulomatous cholecystitis (XGC) causes gallbladder wall thickening with similar aggressive features and closely mimics gallbladder carcinoma clinically, radiologically and surgically. D...
Citations
... 4 Common symptoms and signs at presentation include right upper quadrant abdominal pain, palpable mass (Courvoisier sign), fever, jaundice, positive Murphy's sign on examination, nausea, vomiting, weight loss and thickened gallbladder wall or mass lesion on ultrasound (USS). 8 However preoperative imaging with USS and CT often show features consistent with cholecystitis and cholelithiasis. 8 Gallbladder malignancy has been hypothesised to cause cholecystitis in the absence of gallstones through obstruction of bile flow by the tumour, and the reported incidence of gallbladder malignancy presenting as acute cholecystitis is 2.3%. ...
... 8 However preoperative imaging with USS and CT often show features consistent with cholecystitis and cholelithiasis. 8 Gallbladder malignancy has been hypothesised to cause cholecystitis in the absence of gallstones through obstruction of bile flow by the tumour, and the reported incidence of gallbladder malignancy presenting as acute cholecystitis is 2.3%. 9 Gallbladder SCC exhibits direct and early invasion into liver and adjacent organs including duodenum, stomach and transverse colon, however has lower incidence of lymph node metastases compared to adenocarcinomas. ...
Gallbladder carcinoma is one of the most common and aggressive malignancies to arise from the biliary tract. However, pure squamous cell carcinoma (SCC) originating from the gallbladder is exceptionally rare, reported to represent less than 1% of all malignancies. An 89-year-old Australian male presented with symptoms and imaging consistent with acute calculus cholecystitis. After failed conservative management he underwent a subtotal cholecystectomy. Diagnosis on histopathological examination demonstrated SCC of the gallbladder. This case highlights the importance of considering gallbladder malignancy including rare histological subtypes such as SCC in patients presenting with symptoms consistent with benign gallbladder disease particularly in the elderly population.
... Ultrasound-guided fine-needle biopsy of the lesion is a minimally invasive and promising tool but with a risk of needle tract seeding. Rapid On-Site Evaluation (ROSE) allows early detection and may be part of the first-line test to confirm the diagnosis [13]. However, a contrastenhanced CT scan is still the best modality in terms of diagnosis, tumor extension, local invasion, and presence of distant metastasis [14]. ...
Introduction and importance
Squamous cell carcinoma of the gall bladder is a rare but aggressive tumor. It has a wide variety of presentations. Presentation as a liver abscess is a rare condition only 2 cases reported in the literature before.
Case report
A 45-year-old male patient presented to the emergency with complaints of fever, right upper quadrant pain, and jaundice. On evaluation, an initial diagnosis of the liver abscess was made. Due to the deteriorating condition of the patient, he was taken up for surgery. Upon exploration, there were multiple deposits over the bilateral lobes of the liver, so a controlled drainage of abscess cavity was done with biopsy from the wall of the gall bladder and liver metastasis was taken which showed squamous cell carcinoma of gall bladder with liver metastasis. The patient was given gemcitabine and oxaliplatin as palliative chemotherapy. He died after 11 months of presentation.
Discussion and conclusion
The aggressive and advanced nature of the disease at the presentation poses a formidable challenge in managing such patients but early diagnosis and surgical management can provide long term benefits.
... Gallbladder cancer is a rare neoplasm but most prevalent malignancy in the biliary tract [1]. Adenocarcinoma is the most common variant (97%) but pure squamous cell carcinoma is rare subtype making up only 1% of all gallbladder carcinoma [2]. However, according to Khan et al. the incidence of pure squamous cell carcinoma varies from 0-3.5% [3]. ...
... The incidence of gallbladder cancer is higher in Asian countries like India, Japan [2]. Females are more prone to it (M: nF-1:3) [4]. ...
... Regarding etiopathogenesis, chronic irritation of gallbladder from gallstones may trigger differentiation of gallbladder glandular cells into squamous cells. These squamous metaplastic cells would then undergo malignant transformation [2]. In our case the lumen of gallbladder was studded with stones. ...
... [5][6][7][8] The existing literature on gallbladder SCC, largely consisting of case reports and small case series, suggests that they are more locally invasive but less likely to metastasize than adenocarcinomas. [9][10][11][12] As with adenocarcinoma, complete surgical extirpation is the only definitive treatment for these tumors. [13][14][15] However, outcomes after resection vary significantly between studies. ...
... Chemotherapy, radiation, and surgery were all included in the descriptive analysis. Using the "surgical procedure of the primary site" variable, patients were grouped into those who underwent a simple cholecystectomy (local tumor excision or destruction (10)(11)(20)(21)(22)(23)(24)(25)(26)(27), simple removal of primary site (30), total removal of primary site (40)), radical cholecystectomy (60), debulking (50), surgery of unknown type (90), or no surgery (0). Margin status was classified as R0 (microscopically negative), R1 (microscopically positive), R2 (macroscopically positive), or positive not otherwise specified (NOS) for descriptive analysis, but grouped together as positive (R1, R2, positive NOS) or negative (R0) for survival analysis. ...
Background/Objectives
Gallbladder squamous cell carcinoma (SCC) is an uncommon malignancy whose rarity has made it particularly challenging to study. We utilized a national database to shed light on the clinicopathologic characteristics, management patterns, and survival associated with these tumors.
Methods
Patients with gallbladder SCC were identified in the National Cancer Database. Clinicopathologic and treatment characteristics were recorded and compared with adenocarcinoma for context. Univariate and multivariable survival analyses were completed for patients who underwent resection.
Results
Overall, 1084 patients with SCC and 23 958 patients with adenocarcinoma were identified. Compared with those with adenocarcinoma, patients with SCC had higher grade tumors (P < .001) and were diagnosed at a later stage (P < .001). Patients with SCC were more likely to undergo radical cholecystectomy (17% vs 9%; P < .001), but had a higher rate of margin positivity (36% vs 29%; P < .001). SCC histology was associated with worse survival compared with adenocarcinoma, even after adjusting for R0 resections (13 vs 29 months; P < .001). On multivariable analysis, SCC histology was independently associated with abbreviated survival (P = .003).
Conclusions
Gallbladder SCCs are aggressive cancers that often present at an advanced stage. Complete surgical extirpation should be pursued when feasible. However, prognosis is worse than that of adenocarcinoma, even after R0 resection.
... Various hypotheses have been proposed for the etiology of gallbladder SCC, including: (1) Ectopic squamous epithelium with malignant transformation [1] ; (2) Metaplastic squamous epithelium with malignant transformation which describes the evolution of metaplasia-dysplasia-carcinoma in progressive development [1,13] . The gallbladder may trigger differentiation of glandular cells into squamous cells due to chronic irritation from gallstones. ...
... The gallbladder may trigger differentiation of glandular cells into squamous cells due to chronic irritation from gallstones. Thereafter, the squamous metaplastic cells may undergo malignant transformation into tumor cells [4,8,[13][14][15][16] ; and (3) Adenocarcinoma with squamous metaplasia. Here, squamous cell elements of mixed ASC of the gallbladder undergo excessive growth and eventually replace all the adenocarcinoma components, resulting in SCC development [4,8,[13][14][15][16] . ...
... Thereafter, the squamous metaplastic cells may undergo malignant transformation into tumor cells [4,8,[13][14][15][16] ; and (3) Adenocarcinoma with squamous metaplasia. Here, squamous cell elements of mixed ASC of the gallbladder undergo excessive growth and eventually replace all the adenocarcinoma components, resulting in SCC development [4,8,[13][14][15][16] . ...
Background:
Gallbladder squamous cell carcinoma (GBSCC) is a rare subtype of malignancy and accounts for only 2%-3% of gallbladder malignancies. Due to its rapid development, most patients with GBSCC initially present with an advanced stage of the disease and hence a poor prognosis. The clinicopathological and biological features of SCC remain to be fully elucidated, owing to its uncommon occurrence. The majority of currently available data only described individual case reports or series analyses of trivial cases.
Case summary:
A 64-year-old man was admitted for progressively poor abdominal distension and pain. Liver computed tomography (CT) showed infiltration of gallbladder carcinoma into the adjacent liver, and enlarged retroperitoneal lymph nodes. The patient underwent radical cholecystectomy. Part of the mass was grey and soft, and the neoplastic section showed a purulent-necrotic lesion. Hematoxylin and eosin staining revealed a moderately differentiated SCC. Immunohistochemical studies showed strong staining of the tumor for AE1/3 and CK5/6. Staining for CK19, CK7, and CAM5.2 was positive in the cytoplasm. Systemic chemotherapy was not administered because of the patient's poor physical condition. After five months, CT and magnetic resonance cholangiopancreatography showed multiple metastases in the liver and abdominal cavity.
Conclusion:
Squamous components of GBSCC may explain the complex biological behavior, and CD109 may be involved in the pathogenesis.
... Also noted was common hepatic duct (CHD) obstruction and a large 7.6-cm lesion in hepatic segment 4B, as well as a second smaller lesion within segment 5, which did not enhance with gadolinium (Figs. [3][4][5]. As a result, a likely diagnosis of hepatic abscesses was given with consideration for a superimposed infiltrative neoplastic process. ...
... Primary SCC of the gallbladder is a rare entity that comprises between 1-3% of all primary GB cancers [4,5]. There is a poorer prognosis associated with primary SCC of the gallbladder when compared to the more common AC variant because it is thought to be more locally invasive, and is typically diagnosed at a more advanced T stage [2,4,6]. ...
... Primary SCC of the gallbladder is a rare entity that comprises between 1-3% of all primary GB cancers [4,5]. There is a poorer prognosis associated with primary SCC of the gallbladder when compared to the more common AC variant because it is thought to be more locally invasive, and is typically diagnosed at a more advanced T stage [2,4,6]. The overall mean survival rate for patients with GBC is 6 months, with a 5-year survival rate of 5% [3]. ...
Primary squamous cell carcinoma of the gallbladder is a rare entity that comprises approximately 1%-3% of all primary gallbladder cancers. We report the case of a 37-year-old woman who was diagnosed with a locally invasive squamous cell carcinoma of the gallbladder. Surgical pathology revealed a predominantly squamous cell carcinoma composition of the tumor with a few microscopic foci of adenocarcinoma (<1% of tumor). We discuss pertinent clinical features, risk factors, and imaging characteristics to prompt early diagnosis and treatment, which will ultimately lead to improved patient outcomes.
... 11 Almost all previously reported gallbladder LCNECs described coexisting cholelithiasis with chronic cholecystitis. 5 In this case, 6 chronic cholecystitis with intestinal metaplasia associated with cholelithiasis was identified, which suggested a precursor lesion of the NEC. ...
Large cell neuroendocrine carcinoma (LCNEC) of the gallbladder is extremely rare and usually combined with other type of malignancy, mostly adenocarcinoma. We report an unusual case of combined adenosquamous carcinoma and LCNEC of the gallbladder in a 54-year-old woman. A radical cholecystectomy specimen revealed a 4.3×4.0 cm polypoid mass in the fundus with infiltration of adjacent liver parenchyma. Microscopically, the tumor consisted of two distinct components. Adenosquamous carcinoma was predominant and abrupt transition from adenocarcinoma to squamous cell carcinoma was observed. LCNEC showed round cells with large, vesicular nuclei, abundant mitotic figures, and occasional pseudorosette formation. The patient received adjuvant chemotherapy. However, multiple liver metastases were identified at three-month follow-up. Metastatic nodules were composed of LCNEC and squamous cell carcinoma components. Detecting LCNEC component is important in gallbladder cancer, because the tumor may require a different chemotherapy regimen and show early metastasis and poor prognosis.
Los tumores malignos de intestino delgado son extraordinariamente raros. La mayoría está representada por adenocarcinomas que surgen de adenomas con transformación maligna, así como linfomas y tumores neuroendocrinos. Más frecuentemente, esta porción del tracto gastrointestinal resulta asiento de metástasis de tumores malignos de origen extraintestinal. Presentamos el caso de un carcinoma escamoso de duodeno y se hacen consideraciones importantes a tener en cuenta para el diagnóstico.
Background
Pure squamous cell carcinoma (SCC) of the gallbladder is rare and often confused with the adenosquamous carcinoma (ASC) subtype in previous studies. The present study was attempted to differentiate SCC from ASC by resolving their characteristics and prognosis.
Methods
The Surveillance, Epidemiology, and End Results database was queried for SCC and ASC of gallbladder cases from 1988 to 2015. Patients' clinicopathological characteristics and survival were analysed between the groups.
Results
Of the 709 patients with primary gallbladder cancer included in this study, 249 (35.1%) had pure SCC and the remaining 460 (64.9%) had ASC. It was found that pure SCC was associated with a larger median tumour size (58.0 versus 41.0 mm, P < 0.001), while ASC presented with a worse histological grade (47.4% versus 37.8% for grades III–IV, P = 0.019) and more lymph node invasion (27.4% versus 18.9%, P = 0.041). The 3‐year overall survival and disease‐specific survival rates in pure SCC were lower than those in ASC (7.5% versus 11.5% for overall survival, P < 0.001; 6.2% versus 10.9% for disease‐specific survival, P < 0.001). Multivariate analysis showed that early Surveillance, Epidemiology, and End Results historic stage, treatment with surgery and chemotherapy were significant favourable prognostic factors for pure SCC, while tumour size, late study period, treatment with surgery and radiotherapy were significant predictors for ASC.
Conclusion
There were significant differences in the clinicopathological characteristics and survival prognosis between pure SCC and ASC. Surgery combined with chemotherapy is the preferred treatment option for pure SCC.
