333 Metastatic Squamous Cell Carcinoma of Gall Bladder: Rare Case Report

Abstract Background Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive malignancy, accounting for 1–3% of all gallbladder cancers. It typically presents at an advanced stage due to nonspecific symptoms and is characterized by rapid local invasion. Surgical resection remains the primary treatment, though prognosis is poor, with most patients surviving less than one year. Case A 70-year-old woman presented with severe epigastric pain radiating to the right upper quadrant, worsened by fatty food intake, along with nausea, vomiting, and weight loss. On examination, she had epigastric tenderness and a positive Murphy’s sign. CTAP revealed obstructive hepatic duct dilatation. She underwent three ERCPs for CBD stones while awaiting cholecystectomy. Recurrent admissions with right upper quadrant pain prompted further imaging, which showed an ill-defined hypodense area in the gallbladder fossa extending into the adjacent liver, suspicious for malignancy. Ultrasound-guided biopsy and histopathology confirmed a malignant epithelial neoplasm composed of nests of atypical squamous cells with nuclear pleomorphism, keratin pearls, and desmoplastic stroma, consistent with metastatic squamous cell carcinoma. The case was discussed at MDT, and she was referred to a tertiary centre for further management. Discussion SCC of the gallbladder may arise from chronic inflammation and squamous metaplasia, often associated with gallstones. It mimics adenocarcinoma symptomatically but has more aggressive local invasion. Diagnosis is usually histological. Radical surgery is the mainstay, though often not feasible due to late detection. Conclusions This case highlights the need for early suspicion of gallbladder malignancy in high-risk patients with chronic biliary disease.