DISSCUTION
Gall bladder cancer is the fifth most malignant tumor of the gastrointestinal tract. One of the important risk factors for GBC is cholelithiasis.(6)
Squamous cell carcinoma of the gallbladder is believed to arise from the basal cell layer of the epithelium. It can also result from squamous cell metaplasia or squamous cell carcinoma differentiation from a pre-existing adenocarcinoma. Chronic irritation from gallstones can lead to differentiation of gallbladder glandular cells into metaplastic squamous epithelial cells, which undergo malignant transformation (7).
GB-SCCs are characterized by a high proliferation rate and local invasiveness. Therefore, patients with advanced-stage GB-SCC are diagnosed with a large tumor and involvement of nearby organs(8).
Gallbladder SCC has the worst prognosis of all histological subtypes, with a median survival time of 7 months and a 5-year survival rate of less than 12%(2). Squamous cell carcinoma of the gallbladder is a malignant tumor characterized by rapid proliferation and early spread to local and distant sites (9).
Due to the lack of a serous layer between the gallbladder and the liver, it can invade the liver parenchyma(10 ).The most important treatment method is wide margin surgery. However, the reported resectability rate for these tumors was approximately 50%(11).
One of the most prognostic factors is tumor extension. If the tumor is limited to subserosa and adjacent organs, the 5-year survival rate is 70% and 0%, respectively (12).
Ultrasound is usually the first diagnostic modality, but a definitive diagnosis is confirmed by histology(13).CT scan and MRI should be done to rule out metastasis and surgical planning (5).In early detection of gall bladder SCC, surgery is a curative treatment and can improve the prognosis (14).
Simple cholecystectomy is the standard modality for patients with the Tis stage (carcinoma in situ) or T1a (invading mucosa) stage. For patients at the T1b (invading muscular layer) stage or higher, radical resection, including cholecystectomy, limited segmental resection of the liver(segment IVb. V), and regional lymphadenectomy(15), should be considered. Most patients with gallbladder SCC are locally advanced. Treatments such as chemotherapy, radiotherapy, immunotherapy, and conservative care are appropriate (14).
The benefit of adjuvant therapy in patients with high-risk features, including positive nodes and incomplete resection, is reported in many studies. Still, it is unclear which of the treatments, chemotherapy or radiotherapy, is better. The National Comprehensive Cancer Network recommends chemoradiotherapy(16).In this case report, the patient was treated with surgery (cholecystectomy, wedge resection of liver, and right hemicolectomy) and six courses of adjuvant chemotherapy, and then because of liver metastasis, he underwent four courses of gemcitabine cisplatin pembrolizumab chemoimmunotherapy.
ETHICS STATEMENT
We obtained a written statement of informed consent from the patient for the publication of case details and the use of images. The case discussed in this manuscript does not include patient-identifying information, nor does it report a new study that required IRB approval.
FUNDING INFORMATIONT
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for-profit sectors.
ACKNOWLEDGMENTS
The authors acknowledge the support of Dr.Khodakarim in reporting the study images.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
DATA AVAILABILITY STATEMENT
Data can be obtained from the corresponding author upon request.