Squamous cell carcinoma of the gallbladder

Introduction: Squamous cell carcinoma of the gallbladder (SCCGB) is an extremely rare entity, and most patients present with advanced disease at diagnosis. It has a poor prognosis with a low five-year survival rate. We present two cases with this pathology. Case Series: Case 1: A 61-year-old female presented to our institution with five days of altered mental status, jaundice, and abdominal pain. Initial laboratory work showed evidence of biliary obstruction, severe hypercalcemia, and severe leukocytosis. Computer tomography scan (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an infiltrating mass at the gallbladder neck and hepatic hilum resulting in severe intrahepatic biliary ductal dilation with metastatic adenopathy along with concern for spine and pelvis metastasis. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) was positive for invasive poorly differentiated squamous cell carcinoma. Parathyroid hormone (PTH)-related peptide was elevated. The patient expired during the hospital admission. Case 2: A 74-year-old male presented to our institution with right upper quadrant abdominal pain for one month. Liver enzymes and inflammatory markers were within normal limits. Computed tomography (CT) scan and gallbladder ultrasound (US) showed a significantly distended gallbladder with wall thickening and a focal mass like area present in the body of the gallbladder. Hepatobiliary iminodiacetic acid (HIDA) scan showed non-visualization of the gallbladder worrisome for acute cholecystitis. The patient underwent laparoscopic cholecystectomy with laparoscopic wedge liver biopsy. Pathology was significant for moderately differentiated invasive squamous cell carcinoma. The patient elected for hospice care and was lost to further follow-up. Conclusion: Squamous cell carcinomas of the gallbladder are extremely rare tumors, and the pathogenesis is not well understood. These cancers can closely resemble gallbladder adenocarcinomas but are thought to grow quicker. Although treatment options are improving, SCCGB continues to have a very poor prognosis. More research should be done to gain a better understanding of the disease process and possible curative treatment options.