Synchronous primary gallbladder squamous cell carcinoma and colon adenocarcinoma: A case report and literature review

Abstract

Rationale: Gallbladder (GB) malignancy is the most common biliary malignancy; however, squamous cell carcinoma of the gallbladder (GBSCC) is extremely rare. Synchronous primary GB and colon cancers are very rare, but they are still adenocarcinomas.

Patient concerns: The patient was a 68-year-old male who had symptoms of anemia and underwent a comprehensive examination. Irregular thickening of the GB wall and localized bowel wall thickening in the ascending colon were observed.

Diagnoses: Colonoscopy revealed a large mass in the ascending colon, and adenocarcinoma was diagnosed by biopsy.

Interventions: Right hemicolectomy and extended cholecystectomy were implemented.

Outcomes: The patient was diagnosed with synchronous primary pure GBSCC and colon adenocarcinoma. Anemia was found on the 10th postoperative day, and syncope occurred on the 12th day; computed tomography showed a gastroduodenal artery aneurysm, and covered stent insertion was attempted but failed. Consequently, intimal dissection and common hepatic artery embolization resulted, leading to hepatic failure, and the patient died on the 18th day.

Lessons: We report a case of synchronous primary pure GBSCC and colon adenocarcinoma. Synchronous primary GB and colon adenocarcinomas have rarely been reported. However, synchronous primary pure GBSCC and colon adenocarcinomas have not yet been reported in English literature. Here, we present a literature review on the pathogenesis of GBSCC and synchronous GB and colon cancer.

Keywords: adenocarcinoma; colon; gallbladder; squamous cell carcinoma.

Figure 1.

Preoperative imaging findings. F-18 FDG PET-CT shows hypermetabolism in approximately 6 cm-sized mass in the ascending colon, and in irregular mass involving the GB and adjacent liver.

Figure 2.

Gross findings of the colon and gallbladder tumors. Ulcerofungating cancer involving the proximal ascending colon and cecum is identified (A). Serial section of the gallbladder and adjacent liver shows massive extension of the gallbladder tumor (G) into the liver (L) parenchyma (B).

Figure 3.

Histopathological findings of the colon. Ulcero-fungating and -infiltrative adenocarcinoma is identified from the mucosa to subserosa. NM: adjacent normal mucosa. Scale bar measures 1 mm.

Figure 4.

Histopathological findings of the liver and duodenum. Low magnification of the liver shows direct extension of squamous cell carcinoma in liver parenchyma (A). Higher power view of the liver shows squamous cell carcinoma in the deep portion. Arrow indicates bile duct (B). Duodenum shows infiltrating squamous cell carcinoma in the serosa to proper muscle (C). Higher power view of the yellow boxed area of Figure C shows squamous cell carcinoma in the subserosa and muscle layer (D). L: liver parenchyma. Scale bars measure A: 1 mm, B: 500 µm, C: 1 mm, and D: 200 µm.

Figure 5.

Histopathological findings of the gallbladder tumor. Transmural squamous cell carcinoma in the gallbladder wall (A). Higher power view of the yellow boxed area of Figure A shows squamous cell carcinoma from the mucosa to adventitia (B). Immunohistochemical staining for p40 shows positive nuclear immunoreactivity in the tumor cells (C). Higher magnification of mucosa in Figure B shows well- and moderately differentiated squamous cell carcinoma (D). Scale bars measure A: 1 mm, B: 500 µm, C: 50 µm, and D: 200 µm.

Figure 6.

Histopathological findings of the gallbladder mucosa. Mucosal lining shows abrupt squamous metaplasia (arrows) with chronic inflammation (A). Immunohistochemical staining for p40 shows abrupt positive nuclear staining (arrows) in the squamous metaplasia (B). Immunohistochemical staining for p53 protein shows positive nuclear immunoreactivity in the area of atypical columnar linings (upper 2/3) but negative immunoreactivity in the area of normal-looking mucosal linings (lower 1/3) (C). Scale bar measures 500 µm.

Figure 7.

Chronological summary of the patient. APCT = abdominopelvic computed tomography, A-colon = ascending colon, CHA = common hepatic artery, CSUH = Chosun University Hospital, MRCP = magnetic resonance cholangiopancreatography, GB = gallbladder, GDA = gastroduodenal artery.