Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

Abstract

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 stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer.

Pure squamous cell carcinoma of the gallbladder locally invading the liver and abdominal cavity: A case report and review of the literature

“…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[4,8,13-16]; 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[4,8,13-16].…”

Combined Adenosquamous and Large Cell Neuroendocrine Carcinoma of the Gallbladder

“…Identifying the exact histologic component of the tumor is important because the histologic type is associated with patient prognosis in gallbladder cancers. ACs have a relatively favorable prognosis, whereas tumors with squamous or neuroendocrine differentiation have a poor outcome (mean survival time, 50 vs 23 or 10 months, respectively) [ 2 , 6 ]. LCNEC has been known to exhibit aggressive behavior and early metastasis [ 4 ].…”

A case of primary squamous cell carcinoma of the gallbladder with local invasion of the liver and peritoneum, and metastasis to the omentum

“…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] .…”

“…of patients Age Gender Presentation Imaging findings/diagnostic modality (Dx) Pathology Involvement Survival (mo) Alpuerto et al. (2017) [4] 1 75 F RUQ pain, WBC (15,000/µL), and Normal Liver Function Tests (LFTs) CT: GB wall thickening, pericholecystic fluid, irregular soft tissue mass in GB fundus US: 3.8 cm Heterogeneous GB fundal lesion with small calcifications Dx: Cholecystectomy, duodenal/stomach resection Pure 1° SCC of the GB T4NxMx Local invasion of the liver, duodenum, and stomach Alive at the time of publication Chandna et al. (2016) [7] 1 70 F Dyspepsia, RUQ pain, icterus, and no palpable mass CT: Not performed US: Gallstones with a thickened irregular GB wall Dx: Cholecystectomy Keratinizing SCC confined to the serosa Locally resected tumor with negative margins Not reported Hoshimoto et al.…”