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

Abstract

BACKGROUNDGallbladder 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 SUMMARYA 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.CONCLUSIONSquamous components of GBSCC may explain the complex biological behavior, and CD109 may be involved in the pathogenesis.

Characteristics and survival prognosis of patients with pure squamous cell carcinoma of the gallbladder

“…Current description about the biological behaviour and outcome of pure SCC of the gallbladder is mainly based on case reports and/or small retrospective studies, therefore lacking statistical power. [3][4][5][6][7][8][9][10][11][12][13][14] Using the SEER registry, a large population-based database, we demonstrated that survival of patients with pure SCC was significantly shorter than that of patients with ASC, and their clinicopathological features and prognostic factors were also significantly different, which can discriminate pure SCC and ASC as two distinct entities.…”

“…2 However, there is little knowledge about pure squamous cell carcinoma (SCC) of the gallbladder because of its rarity, accounting for only 2-3% of all GBC cases. 3 Some published studies described the biological behaviour of pure SCC of the gallbladder as local infiltration, less lymphatic metastasis and a worse prognosis as compared with AC and adenosquamous carcinoma (ASC). But as all these studies were based on clinical case reports, the results showed limited statistical power.…”

“…But as all these studies were based on clinical case reports, the results showed limited statistical power. [3][4][5][6][7][8][9] On the other hand, several small sample studies identified pure SCC and ASC as two variants of the same subtype or different progression of the same disease and found that mixed ASC-SCC had a poorer prognosis than AC. However, it is noteworthy that their clinical characteristics vary strongly in the literature, especially with respect to the incidence of lymph node (LN) metastasis (LNM).…”

“…There have been numerous studies addressing the clinicopathological features and management protocols of these malignant tumours 2 . However, there is little knowledge about pure squamous cell carcinoma (SCC) of the gallbladder because of its rarity, accounting for only 2–3% of all GBC cases 3 …”

“…Some published studies described the biological behaviour of pure SCC of the gallbladder as local infiltration, less lymphatic metastasis and a worse prognosis as compared with AC and adenosquamous carcinoma (ASC). But as all these studies were based on clinical case reports, the results showed limited statistical power 3–9 . On the other hand, several small sample studies identified pure SCC and ASC as two variants of the same subtype or different progression of the same disease and found that mixed ASC–SCC had a poorer prognosis than AC.…”