Squamous cell and adenosquamous carcinomas of the gallbladder: clinicopathological analysis of 34 cases identified in 606 carcinomas

Abstract

The information in the literature on squamous cell and adenosquamous carcinomas of the gallbladder is highly limited. In this study, 606 resected invasive gallbladder carcinoma cases were analyzed. Squamous differentiation was identified in 41 cases (7%). Those without any identifiable glandular-type invasive component were classified as pure squamous cell carcinomas (8 cases) and those with the squamous component constituting 25-99% of the tumors were classified as adenosquamous carcinomas (26 cases) and included into the analysis. The remaining 7 that had o25% squamous component were classified as adenocarcinoma with focal squamous change and excluded. The clinicopathological characteristics of adenosquamous carcinoma/squamous cell carcinomas were documented and contrasted with that of ordinary gallbladder adenocarcinomas. The average patient age was 65 years (range 26-81); female/male ratio, 3.8. In only 13%, there was a preoperative clinical suspicion of malignancy. Grossly, 58% presented as thickening and hardening of the wall and 6% were polypoid. In 12%, mucosa adjacent to the tumor revealed squamous metaplasia. All pure squamous cell carcinomas had prominent keratinization. Giant cells and tumor-infiltrating eosinophils were observed in 29 and 51% of the squamous cell carcinomas/adenosquamous carcinomas versus 10% (P ¼ 0.02) and 6% (P ¼ 0.001) in gallbladder adenocarcinomas, respectively. All but three cases had 'advanced' (pT2 and above) carcinomas. Follow-up was available in 31 patients: 25 died of disease (median ¼ 5 months, range 0-20), and 6 were alive (median ¼ 64 months, range 5-112.5). The survival of patients with squamous cell carcinomas/adenosquamous carcinomas was significantly worse than that of gallbladder adenocarcinomas (P ¼ 0.003), and this adverse prognosis persisted when compared with stage-matched advanced gallbladder adenocarcinoma cases (median ¼ 11.4 months, P ¼ 0.01). In conclusion, squamous differentiation was noted in 7% of gallbladder carcinomas. The incidence of adenosquamous carcinoma (defined as 25-99% of the tumor being squamous) was 4%, and that of pure squamous cell carcinoma (without any documented invasive glandular component) was 1%. Pure squamous cell carcinomas often showed prominent keratinization. The overall prognosis of adenosquamous carcinoma/squamous cell carcinoma appears to be even worse than that of ordinary adenocarcinomas. Most patients died within a few months; however, those few who were alive beyond 2 years in this cohort experienced long-term survival.

A study the burden of carcinoma gall bladder in Hamidia hospital of Bhopal, Madhya Pradesh, India

“…In another study, a male to female ratio of 1:1 was seen. 25 Most of the patients in present study had a poor socioeconomic background, similar to that of one study. 26 Gallbladder Carcinoma either remains asymptomatic for a long time or presents with very non-specific symptoms.…”

Clinicopathological Study of Gall Bladder Carcinoma with Special Reference to Gallstones: Our 8-year Experience from Eastern India

“…In contrast, squamous cell or 'epidermoid' carcinomas and adenosquamous carcinomas are rare (Roa et al, 2011). Adenocarcinoma, not otherwise specified, constituted the most common (87.7%) histological type followed by papillary (6.9%) and mucinous (3.8%) adenocarcinoma.…”

Squamous-Cell Gallbladder Carcinoma: How to Treat?

“…In most cases, adjuvant radiotherapy with or without concomitant chemotherapy was used [1,6,9,[20][21][22]. The number of reported cases, the heterogeneity of treatment administered and the limited follow-up for most patients do not allow to draw any conclusion.…”