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.