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      Gallbladder adenosquamous carcinoma: a case report and literature review

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          Abstract

          Representing 90–95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1–5% of all gallbladder carcinomas. These tumors have been shown to have aggressive biologic behavior, commonly extending to adjacent structures. Some studies have shown that the squamous component often displayed a greater proliferative capacity than the adenocarcinomatous component (possibly even up to twice as fast). Complete surgical resection is currently the mainstay of treatment but the prognosis is often poor. In this paper, we present a case of a 69-year-old male with an AJCC Stage IV moderately differentiated adenosquamous carcinoma of the gallbladder treated with radical cholecystectomy including liver segments IVb, V, VI.

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          Adenosquamous/squamous cell carcinoma of the gallbladder.

          Bu-Chin Yu, Mi-Hwa Lee, Kun-Mou Chan … (2007)
          Adenosquamous/squamous cell carcinoma is a rare histopathologic subtype of gallbladder malignancy. Its clinical features have rarely been described, and its differences from the major histopathologic subtype, adenocarcinoma, remain uncertain. All patients with gallbladder carcinoma were retrospectively reviewed. Patients with a histopathologic subtype of either adenosquamous (n = 12) or squamous cell (n = 2) carcinoma were categorized to group I, and patients with adenocarcinoma were categorized to group II. The clinical characteristics and outcomes of these two groups were compared. The two groups were generally no different in clinical features. However, tumor stages of group I patients were significantly advanced (P = 0.048) and included liver involvement (P = 0.008). The outcomes of advanced-stage patients in group II were not different from group I (P = 0.413). Nevertheless, patients in both groups with advanced stage pT who had undergone curative resection showed significantly better survival curves than patients who had undergone non-curative resection (P = 0.003). Patients with adenosquamous/squamous cell carcinoma of the gallbladder were generally similar to those with adenocarcinoma in clinical characteristics, but had a tendency for liver infiltration. Although the two histopathologic subtypes of the gallbladder carcinoma had similar poor outcomes, better survival could be obtained by performing curative resection for these patients. (c) 2007 Wiley-Liss, Inc.
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            Adenosquamous carcinoma of the gallbladder warrants resection only if curative resection is feasible.

            R L H Watanabe, Yoshio Shirai, Y Oohashi … (2002)
            Adenosquamous/squamous cell carcinoma of the gallbladder generally has been considered a lethal disease. The objective of this study was to clarify the effectiveness of resection for patients with adenosquamous/squamous cell carcinoma of the gallbladder. Twenty-nine patients who underwent resection for either adenosquamous carcinoma (n = 28 patients) or squamous cell carcinoma (n = 1 patient) were analyzed retrospectively. Sixteen patients underwent radical resection, whereas the other patients underwent primary tumor resection alone. To elucidate the factors that influenced postresectional survival, 10 variables (age, gender, presence or absence of gallstones, size of the primary tumor, lymphatic vessel invasion, blood vessel invasion, perineural invasion, TNM stage, residual tumor status, and type of resection) were examined. Twenty-three patients (79.3%) were categorized with T3 or T4 tumors that invaded adjacent organs. The outcome after undergoing radical resection (cumulative 5-year survival rate, 48.6%) was significantly better compared with the outcome of patients after undergoing primary tumor resection alone (cumulative 3-year survival rate, 7.7%; P = 0.004). The outcome after undergoing resection was better in 14 patients who had no residual tumor (cumulative 5-year survival rate, 62.9%) compared with the outcome in 15 patients who had residual tumor (cumulative 5-year survival rate, 0%; P < 0.001). Univariate analysis revealed that residual tumor status (P < 0.001), type of resection (P = 0.004), patient age (P = 0.012), and blood vessel invasion (P = 0.017) were significant prognostic factors. Residual tumor status (P = 0.026) was the only significant independent prognostic factor. Adenosquamous/squamous cell carcinoma of the gallbladder warrants resection only if potentially curative (R0) resection is feasible. Copyright 2002 American Cancer Society.
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              Adenosquamous Carcinoma of the Gallbladder: A Clinicopathological, Immunohistochemical and Flow‐cytometric Study of Twenty Cases

              Kazuyoshi Nishihara, Eishi Nagai, Yasuharu Izumi … (1994)
              Twenty patients (7.4%) with adenosquamous carcinoma of the gallbladder were selected from 271 surgically resected gallbladder cancers. The 20 patients were composed of 8 men and 12 women with a mean age of 66.9 years. Histologically, all twenty tumors showed an abrupt transition between the adenocarcinoma (AC) and squamous cell carcinoma (SCC) areas, and well differentiated AC was also found in the peripheral area of the tumor. A histochemical and immunohistochemical study using alcian blue, periodic acid‐Schiff, cytokeratins, involculin and tissue polypeptide antigen disclosed a different nature of the two components. DNA heterogeneity between the components was detected in 5 of 7 cases by flow cytometry. The positive rate of immunostaining for proliferating cell nuclear antigen in the SCC areas (mean 20.55%) was larger than that of the AC areas (mean 11.40%) (P=0.0029), which indicated that the SCC areas had a greater proliferative capacity than AC areas. These results suggest that the SCC component of adenosquamous carcinoma of the gallbladder arose by a stepwise molecular progression of the pre‐existing AC. Furthermore, the prognosis of adenosquamous carcinomas of the gallbladder (mean survival: 10 months) in the advanced stage (pTNM 2–4) was less favorable than those of papillary and well differentiated AC (mean survival: 99 months and 86 months) (p<0.0001).
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                Author and article information

                Contributors
                Tyler Davis
                Paige Moudy
                Mohamed Abdelgawad
                Lutfi Barghuthi:
                ORCID: https://orcid.org/0000-0002-3712-4280
                Hishaam Ismael
                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: September 2021
                Publication date (Electronic): 27 September 2021
                Publication date PMC-release: 27 September 2021
                Volume: 2021
                Issue: 9
                Electronic Location Identifier: rjab365
                Affiliations
                University of Texas Health Science Center at Tyler , Tyler, TX, USA
                Texas College of Osteopathic Medicine , Fort Worth, TX, USA
                University of Texas Health Science Center at Tyler , Tyler, TX, USA
                University of Texas Health Science Center at Tyler , Tyler, TX, USA
                University of Texas Health Science Center at Tyler , Tyler, TX, USA
                Author notes
                Correspondence address. General Surgery, University of Texas Health Science Center at Tyler, 11937 US Hwy 271 Tyler, TX 75708. Tel: (214) 991-0786; E-mail: Tyler.davis@ 123456unthct.edu
                Author information
                https://orcid.org/0000-0002-3712-4280
                Article
                Publisher ID: rjab365
                DOI: 10.1093/jscr/rjab365
                PMC ID: 8478478
                PubMed ID: 34594488
                SO-VID: c60a6fd1-d877-4f94-b8be-bc38f29b929a
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2021.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 June 2021
                Date accepted : 4 August 2021
                Page count
                Pages: 7
                Categories
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/080
                Subject: Case Report

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