En bloc total biliary resection hepatectomy for the treatment of gallbladder adenosquamous carcinoma: a case report

ABSTRACT

Introduction: Gallbladder cancer is a rare type of biliary tract malignancy with poorly defined pathogenesis, difficult treatment and often inoperable.

Case Report: A 84-year-old male presented with pain in the right hypochondrium with three months of progressive worsening. Ultrasound routine examination showed the presence of a large mass in the gallbladder adjacent topography that also showed signs of invasion in the liver tissue. He was submitted to preoperative staging with chest and abdomen MRI with intravenous contrast. A resection of the IVB, V and VI hepatic segments was performed associated to complete resection of the extra hepatic bile duct en bloc. Main bile duct reconstruction with Y-Roux jejunostomy was also performed.

Discussion: Gallbladder carcinoma with squamous component is a rare type of cancer with poor prognosis whose treatment with a curative potential is only possible with surgery, in case the lesion is resectable.

RESUMO

Introdução: O câncer da vesícula biliar é um tipo raro de malignidade do trato biliar com patogênese mal definida, tratamento difícil e muitas vezes inoperável.

Relato de Caso: Um homem de 84 anos apresentou-se com dor em hipocôndrio direito com três meses de piora progressiva. O exame ultrassonográfico de rotina mostrou a presença de uma grande massa na topografia adjacente à vesícula biliar que também apresentava sinais de invasão no tecido hepático. Foi submetido ao estadiamento pré-operatório com RM de tórax e abdome com contraste endovenoso. Foi realizada ressecção dos segmentos hepáticos IVB, V e VI associada à ressecção completa do ducto biliar extrahepático em bloco. Também foi realizada a reconstrução do ducto biliar principal com jejunostomia em Y-Roux.

Discussão: O carcinoma com componente escamoso da vesícula biliar é um tipo de câncer raro e de mau prognóstico, cujo tratamento com potencial curativo só é possível com cirurgia, caso a lesão seja ressecável.

Headings:

Gallbladder neoplasms - Gallbladder diseases - Hepatectomy

Descritores:

Neoplasias da vesícula biliar - Doenças da vesícula biliar - Hepatectomia

• REFERENCES

• 1 Roa JC, Tapia O, Cakir A, Basturk O, Dursun N, Akdemir D. et al. Squamous cell and adenosquamous carcinoma of the gallbladder: clinicopathological analysis of 34 cases identified in 606 carcinomas. Mod Pathol 2011; Aug; 24 (08) 1069-1078
• 2 Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographic distribution and risk factors. Int J Cancer 2006; Apr; 118 (07) 1591-1602
• 3 Henson DE, Schwartz AM, Nsouli H, Albores-Saadreva J. Carcinomas of the pancreas, gallbladder, extrahepatic bile ducts, and ampulla of vater share a field for carcinogenesis: a population-based study. Arch Pathol Lab Med 2009; Jan; 133 (01) 67-71
• 4 Medina E, Kaempffer AM. Cancer mortality in Chile: epidemiological considerations. Rev Med Chil 2001; Oct; 129 (10) 1195-1202
• 5 Adsay NV, Klimstra DS. Benign and malignant tumors of the gallbladder and extrahepatic biliary tract. In: Odze RD, Goldblum JR. eds. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Elsevier: Philadelphia; 2009: 845-875
• 6 Albores-Saavedra J, Henson DE, Klimstra DS. Gallbladder cancer. In: Rosai J. Tumors of the gallbladder, extrahepatic bile ducts and ampulla of vater. Purdy A, Lattes R, eds. Atlas of tumor pathology Washington: Armed Forces Institute of Pathology (AFIP); 2000: 37-106
• 7 Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder cancer in the 21^st century. J Oncol 2015; 2015: 967472
• 8 Agha SA, Fowler AJ, Saeta A, Barai I, Rajmohan S, Orgill DP. et al. The SCARE statement: consensus-based surgical report guidelines. Int J Surg 2016; Oct; 34: 180-186
• 9 Oohashi Y, Shirai Y, Wakai T, Nagakura S, Watanabe H, Hatakeyama K. Adenosquamous carcinoma of the gallbladder warrants resection only if curative resection is feasible. Cancer 2002; Jun; 94 (11) 3000-3005
• 10 Kalayarasan R, Javed A, Sakhuja P, Agarwal AK. Squamous variant of gallbladder cancer: Is it different from adenocarcinoma?. Am J Surg 2013; Sep; 206 (03) 380-385
• 11 Tella SH, Kommalapati A, Borad MJ, Mahipal A. Second-line therapies in advanced biliary tract cancers. Lancet Oncol 2020; Jan; 21 (01) e29-e41
• 12 Aldossary MY, Alayed AA, Amr S, Algahtani MS. Primary squamous cell carcinoma of the gallbladder: report of a rare neoplasm from the Eastern Province of Saudi Arabia. In J Surg Case Rep 2018; 51: 186-189
• 13 Weathrall TJ, Fenton M, Munene G, Dickson PV, Deneve JL. Locally advanced, unresectable squamous cell carcinoma of the gallbladder. Case Rep Surg 2015; Jul; 2015: 424650
• 14 Song HW, Chen C, Shen HX, Ma L, Zhao YL, Zhang GJ. et al. Squamous/adenosquamous carcinoma of the gallbladder: analysis of 34 cases and comparison of clinicopathologic features and surgical outcomes with adenocarcinoma. J Surg Oncol 2013; 112 (06) 677-680
• 15 Zou XP, Wang JY, Jiang YY, Chen G, Mo WJ, Feng ZB. Clinicopathological features and survival of gallbladder squamous cell carcinoma: analysis of 121 cases. Int J Clin Exp Pathol 2018; 11 (07) 3208-3221
• 16 Cho JK, Lee W, Jang JY, Kim HG, Kim JM, Kwag SJ. et al. Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: a retrospective study. World J Surg Oncol 2019; 17: 8-18
• 17 Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH. et al. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci 2014; 29 (10) 1333-1340
• 18 Eckel F, Brunner T, Jelic S, Groupa EGW. Billiary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; Sep; 22 (Suppl 6): vi40-4
• 19 National Comprehensive Cancer Network (NCCN). The NCCN Clinical Practice Guidelines in Oncoloy (NCCN Guidelines^TM) hepatobiliary cancers (version 2.2015). Plymouth Meeting: NCCN; 2015
• 20 Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A. et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; Apr; 362 (14) 1273-1281
• 21 Ma N, Hui C, Qin B, Zhong R, Wang B. Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis. BMC Cancer 2015; Sep; 15: 615-624