Primary squamous cell carcinoma of the gallbladder: Report of a rare neoplasm from the Eastern Province of Saudi Arabia

Clinical Characteristics and Outcome Between Gallbladder Squamous Cell Carcinoma and Adenocarcinoma: A Propensity Matched Analysis Based on the Surveillance, Epidemiology, and End Results Database

Background

Gallbladder squamous cell carcinoma (GSCC) is a rare carcinoma with limited evidence in literature, making it particularly difficult to study. Surveillance, Epidemiology, and End Results Database (SEER) were used to stress the clinicopathological features and outcomes associated with this tumor.

Methods

SEER registries were used to identify GSCC and gallbladder adenocarcinoma (GAC) cases from 2004 to 2015. The Propensity matching (PSM) method was used for minimized potential difference between the two types and the utmost. Patients with GSCC versus GAC were compared using the clinicopathological features and outcomes.

Results

There were 121 patients with GSCC and 6 580 patients had GAC. Compared with the GAC cohort, the GSCC cohort had a lower proportion of well-differentiated histology (3.3% vs. 12.1%, p < 0.001) and was diagnosed at a later T-stage (p < 0.001). Regarding treatment, patients treated with surgery, chemotherapy or radiation were associated with significantly better outcome than patients without undergoing these treatment modalities. In both univariate and multivariate analyses, GSCC histology was associated with worse prognosis than GAC histology.

Conclusions

Patients with GSCC were associated with a worse outcome than the GAC cohort. The independent risk factors for patients with GSCC are surgery and chemotherapy.

Unexpected histopathology results following routine examination of cholecystectomy specimens: How big and how significant?

BACKGROUND

Routine histopathological examination (RHPE) of all gallbladder specimens is required to detect the presence of gallbladder carcinoma (GBC) or any other pathology. The work aims to study the incidence and the clinical significance of detecting unusual gallbladder findings upon the RHPE of the referred cholecystectomy specimens to a histopathology laboratory section at a referral hospital in Saudi Arabia during one year period.

MATERIALS AND METHODS

From May 2019 to May 2020, all histopathology reports of 444 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed and divided into two groups; usual findings and unusual findings which were reviewed blindly by two other pathology consultants. Frequencies, descriptive statistics, normality test, and correlations were run. The Interrater reliability between clinical and histopathological diagnosis was assessed statistically by kappa test.

RESULTS

The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 296 out of 444 total cases (66.7%), acute cholecystitis in 52 cases (11.7%), and other associated usual findings in 85 cases (19%). Three cases (0.7%) of incidental carcinomas and other three cases (0.7%) of dysplasia. Eosinophilic carcinomas were detected in two cases (0.45%), gallbladder complete septum was found in one case, and one case of Phrygian cap anomaly. All patients with gallbladder carcinoma were diagnosed incidentally during the histopathological examination.

CONCLUSIONS

RHPE of cholecystectomy materials are required to confirm the final diagnosis and document any other pathology. Failure to detect incidental occult carcinoma may be catastrophic, given the poor prognosis.

Surgical resection of advanced gallbladder squamous cell carcinoma accompanied by infiltration of the surrounding organs and general peritonitis

INTRODUCTION

Squamous cell carcinoma (SCC) of the gallbladder is rare, accounting for merely 1-3% of all gallbladder cancers.

PRESENTATION OF CASE

A 59-year-old Japanese man was referred to our hospital with a chief complaint of right lower abdominal pain. He was diagnosed with gallbladder cancer after comprehensive testing. Computed tomography (CT) imaging revealed an enlarged gallbladder, and a lumen full of tumors (maximum tumor size was 90 mm in diameter.). The patient was, therefore, admitted to our department for the operation. After admission, the patient developed a fever and pain in his lower right abdomen. Palpation revealed masses in the abdomen and right hypochondrium. Blood tests revealed elevated levels of inflammatory markers. Therefore, a conservative treatment approach was performed prior to surgery. After then, the patient's abdominal symptoms did not seem to worsen, and his vital signs were stable, leading us to continue the conservative treatment approach. The operation was conducted on a semi-urgent basis. Surgical findings: The patient was diagnosed with gallbladder cancer with traverse colon infiltration. We performed hepatic resection (S4a + S5), biliary reconstruction, lower (pyloric) gastrectomy, right hemicolectomy, and ileostomy. Histopathological findings revealed that the patient was diagnosed with advanced gallbladder SCC.

DISCUSSION

Primary SCC of the gallbladder is associated with poor prognosis. Continuing to collect and document such cases will help to resolve this matter.

CONCLUSION

This report details our experience in treating a case of "pure" gallbladder SCC, a rare subtype of gallbladder cancer. Despite the complicating general peritonitis, we were still able to safely perform a radical resection to remove it.

Surgical outcomes of primary carcinosarcoma of the gallbladder after curative resection: A rare case series

INTRODUCTION

Primary carcinosarcoma is a rare neoplasm of the gallbladder, and is characterized by collision elements of the adenocarcinomatous and sarcomatous components. The tumours comprise both malignant epithelial and mesenchymal elements, and are usually very aggressive, conferring poor prognosis. Adenocarcinomas are the most common neoplasms of the gall bladder, while carcinosarcoma are extremely rare, with a global prevalence rate of less than 1%. The low incidence of carcinosarcoma greatly hinders the understanding of its aetiology.

PRESENTATION OF CASE

Here, we report the surgical outcome of 3 rare cases of gallbladder carcinosarcomas, two of which had a IVB stage disease and in one case the staging was II. Following surgery, the survival in the former was less than 1 year, while in the latter, it extended up to 7 years (86 months), and the patient is alive till date. This study aimed to elucidate the surgical outcomes and prognosis after curable resection for carcinosarcomas of the gallbladder.

DISCUSSION

The findings suggest that carcinosarcomas are associated with a poor prognosis and short survival, particularly in those with tumours of >5 cm. In the absence of effective adjuvant treatment, surgery remains the mainstay of treatment.

CONCLUSION

Complete surgical resection may improve prognosis and extend survival in patients with this rare and aggressive form of gallbladder cancer.