Invasive Squamous Cell Carcinoma of Gallbladder Presenting as Colonic Obstruction

Abstract

Introduction: Gallbladder cancers are rare, with the most common histologic variant to be adenocarcinoma. Pure squamous cell carcinomas (SCC) are extremely uncommon accounting for 2% of all gallbladder cancers. Multiple risk factors have been identified including gallstones, porcelain gallbladder, polyps, biliary cysts, chronic infections, anomalous pancreatobiliary duct junction, and carcinogenic exposure. We report a case of squamous cell carcinoma of the gallbladder presenting with 3 months of abdominal pain associated with constipation and nausea, vomiting, and distention. Her initial ultrasound revealed cholelithiaisis but otherwise normal biliary tree and gallbladder, and after consultation with a surgeon she was scheduled for an outpatient cholecystectomy. However, during the interval period she had worsening of her symptoms and she also endorsed a 10-pound weight loss. Computed tomography (CT) of her abdomen showed a heterogeneously enhancing mass surrounding the colon with noted obstruction at the hepatic flexure and proximal colon, as well as cecal dilation. She then underwent a colonoscopy that found a mass causing a partial colon obstruction at the hepatic flexure. Subsequently, a colonic stent was placed using a guide wire, to relieve the obstruction and numerous biopsies were taken. Biopsies revealed invasive SCC that infiltrated submucosal soft tissues which was positive for cytokeratin 7, 5, 6, and p63, suggestive of gallbladder primary. She then underwent laparoscopy and biopsies of the intra-abdominal mass, which again showed locally invasive SCC arising from the gallbladder. Given her locally advanced status, she was not felt to be a surgical candidate, and was started on systemic therapy with gemcitabine and cisplatin. Despite chemotherapy, however, patient returned within 2 months with numerous necrotic metastases throughout her liver, demonstrating the difficulty in treating these type of cancers.Figure 1: Axial CT images.Figure 2: Bulging mass on the right lateral wall and colon stent placement.Figure 3: Laproscopic images of right upper quadrant mass and transverse colon. Mass is fixed and invading the liver.