•Am J Med Su g – Oc obe 2025; 21 (2). 1-4
www.amjmedsu g.o g DOI 10.5281/zenodo.17314262
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Squamous cell ca cinoma o he gallbladde .
A case epo
Luis En ique Año e Cas o M.D.
Luis Guille mo Ramos G acia M.D.
And es Aldape Mo a M.D.
Josue Is ael Oli a es del Mo al M.D.
Raúl Alejand o López Saucedo M.D.
Jose Juan Rami ez Jaime M.D.
Aguascalien es, Mexico
allbladde cance is g ouped as bilia y ac
cance and co esponds o less han 1% o
cance in o al popula ion, he incidence is
dispe sed USA p esen (0.3-0.5 / 100000 cases),
howe e his inc eases o he popula ion o China-
Ko ea-Indonesia p esen ing (40-85/100000 cases). In
Mexico 1.1/100 000 cases in men and 2.4/100 000
cases in women. Globocan 2020 [1] indica es each
yea app oxima ely 115,000 new cases, p esen ing
0.6% o incidence in all cance s wo ldwide, p esen ing
a mo ali y o 0.8%.
Acco ding o he lineage o his ological
cha ac e is ic 70-90% o gallbladde umo s a e
adenoca cinomas, 10-20% epide moid, howe e
squamous cell ca cinoma is a a e and poo ly
diagnosed en i y, ep esen ing app oxima ely 1-3% [3]
o cases, i s impo ance ep esen s a mo e agg essi e
beha io compa ed o adenoca cinomas.[4] I is an
en i y cha ac e ized by ke a in pea ls p esen ing a
p edominan ke a iniza ion, wi h p obable malignan
glandula ans o ma ion [5]. in heo y i is a a ie y o
gallbladde cance o igina ing om a squamous
me aplasia o a p e-exis ing adenoca cinoma, which is
gene a ed me aplasia-dysplasia-ca cinoma sequence,
some bibliog aphies ca alog i as a mixed gallbladde
cance (adenoca cinoma-epide moid). [6]
I has been demons a ed ha cholecys i is
wi h ch onic pe sis en in lamma ion is he mos
impo an isk ac o o he de elopmen o
gallbladde cance , he e a e o he ac o s such as
women, age be ween he i h o six h decade o li e,
gallbladde polyp o e 1 cm, po celain gallbladde ,
ch onic in ec ion by salmonella yphi, in lamma o y
bowel disease and p ima y scle osing cholangi is. [7]
The s aging o gallbladde cance depends on
he in asion wi hin he wall (T), in asion o lymph
nodes (N) and me as a ic disease (M), his acco ding
o he AJCC [12] [Figu e 2][8]. I is known ha he
ac o , he diagnosis can be suspec ed in pa ien s wi h
ele a ed CEA g ea e han 100u/ml, his o y o
choleli hiasis, ul asound has a sensi i i y o 50% o
diagnosis o cance , his being o limi ed use ulness,
CT o e s g ea e sensi i i y wi h lesions la ge han 1-
2 cm, also allows a loco egional s aging. Howe e ,
cholangio esonance is nonin asi e, has a sensi i i y
g ea e han 95%, being his he bes imaging s udy o
diagnosis. Endoscopic e og ade
cholangiopanc ea og aphy allows o e alua e he
in eg i y o in ol emen o he main bilia y ac ,
some imes allows b ushing wi h biopsy. [9]
Su gical ea men is he only cu a i e
managemen , he e a e 3 scena ios whe e he diagnosis
is made, and su gical managemen should be gi en.
The mos equen diagnosis made a e
G
Backg ound: Gallbladde cance accoun s o a o al o 1% o cance s in he
wo ld, Globocan men ions an incidence o 115000 [Figu e 1], new cases pe
yea , wi h a mo ali y o 0.8% o all cance s in he wo ld. I s his ological
lineage adenoca cinoma and epide moid encompass mo e han 95% o he
his ological lineage, howe e squamous cell ca cinoma is a a e en i y, he e
is s ill no enough scien i ic e idence o he incidence, i is es ima ed 1-3% o
he sub ypes o gallbladde cance , and i is seconda y ke a in beads ha
p esen a p edominan ke a iniza ion, wi h p obable malignan glandula
ans o ma ion. Diagnosis is a challenge, isk ac o s mus be conside ed,
TNM s aging, and inally su gical managemen is he only cu a i e ea men
and he cos o adical o ex ended cholecys ec omy, associa ed wi h
chemo he apy and adio he apy. Su i al and ollow-up in hese pa ien s a e
impo an . In his case we a e dealing wi h a 48-yea -old pa ien wi h a pos -
su gical diagnosis o squamous cell ca cinoma o he gallbladde , a a e and
poo ly epo ed en i y.
Keywo ds: Gallbladde cance .
Gene al Su ge y
Case
Repo
F om
he
Gene al
Su ge y Depa men a
Cen ena io Hospi al M
iguel Hidalgo. Aguascalien es, Mexico
.
Recei ed on
Sep embe 30
, 2025.
Accep ed on
Oc obe
7
,
2025. Published on Oc obe 10, 2025.
Año e Cas o LE. e al. Am J Med Su g - Oc obe 2025; 21 (2). 1-4
www.amjmedsu g.o g DOI 10.5281/zenodo.17314262
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Figu e 1-2. Gallbladde wi h a 12 mm hickened wall, wi h li hiasis
la ge han 15 mm, ee liquid, desmoplas ic eac ion, and ib osis.
cholecys ec omy ( o al o sub o al)[10], less equen ly
suspicion and con i ma ion in he p eope a i e pe iod
and inally gallbladde cance con i med by
ansope a i e s udy. Su gical managemen consis s o
adical cholecys ec omy, o some imes ex ended wi h
segmen al o lobula li e esec ion, always
conside ing he lymphadenec omy. In pa ien s wi h
me as a ic disease o ex ensi e loco egional
in ol emen , chemo he apy wi h o wi hou
adio he apy should be p esc ibed. [10]
Follow-up is done wi h ou pa ien isi s om
3 o 6 mon hs du ing he i s 2 yea s and isi s om 6
o 12 mon hs up o 5 yea s o acco ding o he clinical
con ex , wi h CT, CA 19.9, CEA and clinical beha io .
[11]
Case epo
The pa ien is a 48-yea -old emale wi h a
his o y o smoking and occasional alcoholism since
he age o 18. No o he impo an ac o .
She s a ed he condi ion 30 days p io o
hospi aliza ion wi h symp oms o dyspepsia associa ed
wi h cholecys okine ic ood, no pain, no e e , no
weigh loss, wi h ee e olu ion, un il he de elopmen
o jaundice and gene alized p u i us, so she came o
ou uni o ca e.
A ou e alua ion she was ound wi h jaundice
++/+++, asymp oma ic, a eb ile, no nausea, no pain,
so dep essible abdomen, no palpable mass, no pain
on p essu e, no e idence o pe i oneal i i a ion.
Pa ien has li e unc ion es s o Albumin 3.8,
GGT 363, TGO 181, TGP 296, Alkaline Phospha ase
Figu e 3-4. Squamous cells a e obse ed in his opa hology sample
o gallbladde .
407, Lac a e Dehyd ogenase 328, To al Bili ubins 4.7,
Di ec Bili ubin 3. 7, Blood chemis y wi h Amylase
45, C Reac i e P o ein 32.4, Blood Biome y wi h
Hemoglobin o 11.4, Pla ele s 501, whi e cell coun
7.42 wi h 71% segmen ed and CA 19.9 o 500 u/ml.
Ul asound wi h he e ogeneous li e , wi hou
in a o ex ahepa ic bile duc dila a ion, common bile
duc o 7 mm, po al ein o 9 mm. Gallbladde
27x43x38mm, 5 mm wall, he e ogeneous con en
compa ible wi h mud, mul iple li hos and ee liquid.
Pa ien is accep ed in he su ge y se ice wi h
he diagnosis o choleli hiasis wi hou da a o
exace ba ion, wi h high isk o choledocholi hiasis, so
Año e Cas o LE. e al. Am J Med Su g - Oc obe 2025; 21 (2). 1-4
www.amjmedsu g.o g DOI 10.5281/zenodo.17314262
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Figu e 5. CT scan; Lesion adjacen o hepa ic segmen s IV and V
o i egula cha ac e is ics, wi h pe icoledochal lymph node
ac i i y ha gene a es comp ession o he bile duc .
i is p og ammed o lapa oscopic cholecys ec omy
wi h Endoscopic Re og ade
Cholangiopanc ea og aphy (ERCP).
The pa ien unde wen he p ocedu e 2 days
a e hospi aliza ion. An a emp was made o pe o m
ERCP du ing he i s s ay, howe e , nei he a
guidewi e no a sphinc e o ome could be cannula ed,
so i was decided o con inue wi h lapa oscopic
cholecys ec omy o pe o m Rendez-Vous.
Du ing lapa oscopic cholecys ec omy
indings, a 14x10x9mm in lamed, nec o ic gallbladde ,
12mm hickening, wi h signi ican desmoplas ic
in il a ion wi h in il a ion owa ds IVa segmen s,
edema and ee liquid. I is classi ied as Pa kland V,
gallbladde wi h plas on and i m adhesions wi hou
being able o dissec s uc u es, so he decision was
made o pe o m a ype D sub o al cholecys ec omy
[Figu e 1-2]. An a emp was made o pe o m
Rendez-Vous du ing lapa oscopic cholecys ec omy,
howe e , i was no possible o pass a guide h ough
he cys ic duc due. Aspi a i e so d ainage is le in
he cys ic duc .
Subsequen ly, a second ERCP a emp was
made, a e se e al a emp s, he bilia y ac was
cannula ed wi h a wo-way echnique,
cholangiog aphy was pe o med wi h wa e -soluble
con as medium, obse ing a dila ed bilia y ac up o
9 mm, wi hou obse ing he passage o con as
medium in he middle hi d o he common bile duc ,
wi hou obse ing he es o he bilia y ee. A e a
new a emp a cholangiog aphy, he igh hepa ic duc
wi h i s an e io and pos e io b anches was iden i ied.
Sweeps we e pe o med wi hou ob aining sludge o
Figu e 6. Comp ession and illing de ec o he main bile duc and
a he le el o he hepa ic con luence, in he bilia y econs uc ion
o magne ic cholangio esonance, wi h p obable ex insic
comp ession.
li hium, wi h p obable ex insic comp ession, and a
10cm x 10 F plas ic bilia y p os hesis was placed.
A su gical specimen o gallbladde was sen o
be s udied, wi h his opa hological esul o in il a ing
ca cinoma, squamous cell ype, G ade 1, well
di e en ia ed, in body and neck o gallbladde , wi h
umo dimensions o 3.6x1.3cm, wi h mac oscopic
pe o a ion o he se osa, lympho ascula in asion
p esen , wi h su gical ma gins in con ac wi h he
lesion, his opa hological yping pT3, N no assessable,
M no assessable. [Figu e 3-4]
Double con as CT scan was pe o med,
iden i ying a lesion o 4x4x2 cm wi h con as
enhancemen , i egula , adjacen o hepa ic segmen s
VI and V, wi h lymph node ac i i y in he common
bilia y ac in he uppe hi d. [Figu e 5], Subsequen
magne ic esonance cholangiog aphy whe e pos -
su gical changes a e isualized wi h esicula neck
emnan , wi h pe icolecys ic hickening and
in lamma o y-comp essi e changes in he p oximal
hi d o he bilia y ac , wi h in ol emen o he
con luence o he igh and le hepa ic duc s. [Figu e
6]
Pa ien wi h adequa e clinical e olu ion,
ole a ing die , wi hou pain, d ainage ou pu o
se ohema ic cha ac e is ics is obse ed. She is
discha ged and su gical managemen wi h ex ended
cholecys ec omy is planned.
Discussion
In his clinical case as men ioned by he
scien i ic e idence, he incidence o gallbladde cance
Año e Cas o LE. e al. Am J Med Su g - Oc obe 2025; 21 (2). 1-4
www.amjmedsu g.o g DOI 10.5281/zenodo.17314262
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
is mo e equen in he emale sex om he i h
decade, wi h a his o y o choleli hiasis/cholecys i is,
hickened gallbladde wall, hese ac o s we e p esen
in ou pa ien . Pa aclinical es s we e also aken,
iden i ying ele a ed leukocy es, o al bili ubin a he
expense o di ec bili ubin, wi h CA 19.9: 500 u/ml,
being 5 imes highe han he limi (100 u/ml).
Acco ding o he his ological sub ype o gallbladde
cance , p e iously commen ed he o de , being
adenoca cinoma and epide moid in mos cases, in less
equency he squamous ypes o gallbladde
ca cinomas, in ou pa ien was e idenced in he
his opa hology in il a ing ca cinoma wi h squamous
cell ype, g ade 1, well di e en ia ed, wi h umo
ex ension a ec ing he se osa (T3), being his a a e
en i y and wi h poo scien i ic documen a ion.
The e a e 3 scena ios o diagnosis o
gallbladde cance , a) pos -su gical diagnosis a e
cholecys ec omy, b) p e-su gical diagnosis and c)
diagnosis a he ime o su ge y wi h ansope a i e
diagnosis. In his case, he diagnosis was pos -su gical,
being complemen ed wi h double con as and
iphasic omog aphy, since i allows loco egional
s aging, whe e he e is e idence o segmen IVa-
dependen lesion, wi hou egional lympha ic ac i i y,
wi hou dis an me as a ic ac i i y.
Cu a i e su gical managemen is ex ended o
ex ended adical cholecys ec omy (cholecys ec omy
wi h a minimum ma gin o 2 cm o he gallbladde bed
wi h o wi hou segmen al o lobula li e esec ion
and lymph node dissec ion o he hepa oduodenal
ligamen , nodes pos e io o he second po ion o he
duodenum, panc ea ic head, and celiac unk) is
indica ed in pa ien s wi h clinical s age IIIA and IIIB
o less. Ou pa ien p esen ed se osal in asion (T3),
lymph node ac i i y in he common bile duc (N1) and
no dis an me as asis (M0), she is classi ied as clinical
s age IIIB, being a candida e o su gical managemen
wi h ex ended adical cholecys ec omy wi h adju an
chemo he apy and adio he apy.
Conclusion
Squamous ca cinoma o he gallbladde is a
a e en i y, in equen and wi h li le scien i ic
e idence o da e. Diagnosis is usually la e s age;
su gical managemen is he bes ea men s a egy. I
is necessa y o epo mo e cases and imp o e he
knowledge o his speci ic en i y o ha e an ea ly
diagnosis and imp o e su i al.
Con lic s o in e es s
The au ho s ha e no con lic s o in e es s.
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Luis En ique Año e Cas o
Gene al Su ge y Depa men
Cen ena io Hospi al Miguel Hidalgo
Aguascalien es Mexico
