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Primary squamous cell carcinoma of the liver has previously been reported to arise only from the lining of a developmental hepatic cyst or in a hepatic teratoma. The authors describe the occurrence of such a tumor in association with multiple intrahepatic cholesterol gallstones. It is suggested that the gallstones may have caused squamous metaplasia of the lining of the bile ducts and that this in turn was responsible for squamous carcinoma formation.