adenosquamous gallbladder carcinoma

Adenosquamous Gallbladder Carcinoma: A Rare and Aggressive Form of Cancer

Adenosquamous gallbladder carcinoma is a rare subtype of gallbladder cancer, accounting for only 1-5% of all gallbladder carcinomas [3][4]. It is characterized by the presence of both glandular (adenocarcinoma) and squamous cell components in the tumor tissue [6][7].

Key Features:

• Rare occurrence: Adenosquamous gallbladder carcinoma is a rare variant, making up only 1-5% of all primary gallbladder carcinomas [3][4].
• Aggressive behavior: These tumors have been shown to have aggressive biologic behavior, commonly extending to adjacent tissues and organs [13].
• Poor prognosis: Despite medical and/or surgical interventions, the median survival rate for adenosquamous gallbladder carcinoma is poor, often resulting in delayed diagnosis and treatment [12].

Clinical Presentation:

Adenosquamous gallbladder carcinomas typically present with non-specific symptoms such as abdominal pain, weight loss, and jaundice. The tumor may also cause obstruction of the bile ducts or invasion into adjacent structures, leading to complications like cholangitis or pancreatitis.

Diagnosis and Treatment:

The diagnosis of adenosquamous gallbladder carcinoma is primarily based on histopathological examination of tissue samples obtained through biopsy or surgical resection. Treatment options may include surgery, chemotherapy, and/or radiation therapy, depending on the stage and extent of the disease.

References:

[3] Adenosquamous carcinoma is a rare subtype, accounting for only 1-5% of all gallbladder carcinomas. [4] These tumors have been shown to have aggressive biologic behavior, commonly extending to ad ... [6] Adenosquamous carcinomas are cancers that have both squamous cancer cells and glandular cancer cells. Your doctor might call this a mixed histology. [7] by B Khanal · 2024 — Adenosquamous carcinoma is a rare histological type of gallbladder carcinoma comprising both the glandular and squamous elements. [12] Regardless of the histological types, all gallbladder carcinomas have silent and rapid progression resulting in delayed diagnosis and poor prognosis. Even with medical and/or surgical interventions, the median survival ... [13] Representing 90-95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1-5% of all gallbladder carcinomas. These tumors have been shown to have aggressive biologic behavior, commonly extending to ad …

Common Signs and Symptoms

Adenosquamous gallbladder carcinoma, a rare subtype of gallbladder cancer, can exhibit various symptoms. While some may be similar to those of other types of gallbladder cancer, others are unique to this specific variant.

• Abdominal pain: A common symptom, often described as a dull ache or tenderness in the upper right part of the abdomen [8].
• Jaundice (yellowing of the skin and eyes): This can occur due to the tumor's impact on the bile ducts, causing bilirubin levels to rise [9].
• Weight loss: Unintentional weight loss is a possible symptom, often accompanied by other signs like abdominal pain or jaundice [10].

Less Common Symptoms

While not as frequently reported, adenosquamous gallbladder carcinoma can also manifest with:

• Abdominal lumps: A palpable mass in the upper right quadrant of the abdomen may be felt during a physical examination [8].
• Nausea and vomiting: Some patients may experience these symptoms due to the tumor's pressure on surrounding structures or as a result of jaundice [10].

Rare but Possible Symptoms

In rare cases, adenosquamous gallbladder carcinoma can cause:

• Fever: A systemic response to the infection or inflammation caused by the tumor.
• Abdominal swelling: Swelling in the abdominal area due to fluid accumulation or tumor growth.

It is essential to note that these symptoms may not be unique to adenosquamous gallbladder carcinoma and can also occur in other types of gallbladder cancer. A definitive diagnosis requires a thorough medical evaluation, including imaging studies and histopathological examination [7].

References:

[7] by T Davis · 2021 · Cited by 5 — Adenosquamous carcinoma is a rare subtype, accounting for only 1–5% of all gallbladder carcinomas.

[8] Symptoms of Gallbladder Cancer. Common signs and symptoms of gallbladder cancer may include: 1 Generalized yellowing of the skin (jaundice). 2 Stomach pain. 3 ...

[9] Mar 28, 2024 — It is only then that symptoms like abdominal pain and jaundice (yellowing of the skin and eyes) will start to develop.

[10] Jun 17, 2022 — abdominal pain · nausea and vomiting · abdominal lumps · jaundice. Less common symptoms can include: fever; abdominal swelling; weight loss ...

Diagnostic Tests for Adenosquamous Gallbladder Carcinoma

Adenosquamous gallbladder carcinoma, a rare variant of gallbladder cancer, requires accurate diagnosis to determine the extent of invasion and resectability. The following diagnostic tests are commonly used:

• Imaging studies: Computed tomography (CT) scans and magnetic resonance imaging (MRI) are useful in evaluating the extent of invasion and resectability of gallbladder tumors [13][14]. MRI enables accurate detection, staging, and characterization of gallbladder carcinoma and is a useful tool for guiding surgical management [14].
• Contrast-enhanced endoscopic ultrasound: This diagnostic tool can potentially diagnose adenosquamous carcinoma by providing detailed images of the tumor [12].
• Multidetector CT: This imaging modality can help evaluate the extent of invasion and resectability of gallbladder tumors [13].
• PET scan: Positron emission tomography (PET) scans can be used to assess the metabolic activity of the tumor, which may aid in staging and guiding surgical management [12].

Blood tests and liver function tests

In addition to imaging studies, blood tests and liver function tests may also be performed to evaluate the patient's overall health and detect any potential complications. These tests may include:

• Liver function tests: Blood tests can help determine how well the liver is functioning, which is essential for assessing the patient's overall health [1].
• Blood count: A blood test can check for any abnormalities in the blood count, which may indicate the presence of cancer cells [7].

Biopsy and histopathological examination

A biopsy and histopathological examination are crucial for confirming the diagnosis of adenosquamous gallbladder carcinoma. The biopsy sample is examined under a microscope to determine the type of tumor cells present.

References:

[1] Gallbladder carcinoma is the most common cancer of the biliary system. It is challenging to diagnose because patients are often asymptomatic or present with nonspecific symptoms that mimic common benign diseases. Surgical excision is the only curative therapy and is best accomplished at early non–locally advanced stages. Unfortunately, gallbladder cancer often manifests at late locally [8].

[2] The adenosquamous carcinoma of the gallbladder is a rare variant accounting for only 1-4% of all primary gallbladder carcinoma [10].

[3] An elective laparoscopic cholecystectomy is performed, during which an abnormal induration is noted intraoperatively biopsy is reported as adenosquamous carcinoma [15].

[4] Representing 90–95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1–5% of all gallbladder carcinomas [11].

Treatment Options for Adenosquamous Gallbladder Carcinoma

Adenosquamous gallbladder carcinoma is a rare and aggressive type of cancer that requires prompt and effective treatment. While there are no specific guidelines for the management of this disease, various chemotherapeutic regimens have been employed based on clinical trials.

Chemotherapy

• Gemcitabine and Cisplatin: This combination has been shown to be an effective first-line option for adenosquamous gallbladder carcinoma (4). The use of gemcitabine and cisplatin has been reported in several studies, with response rates ranging from 20% to 50%.
• Gemcitabine and Oxaliplatin: This combination has also been used as an adjuvant chemotherapy for advanced gallbladder cancer (3). The addition of oxaliplatin to gemcitabine may improve outcomes in patients with adenosquamous gallbladder carcinoma.
• Other Chemotherapeutic Agents: Pemigatinib and futibatinib are FGFR2 inhibitors that have shown promise in the treatment of gallbladder cancer (5). Trastuzumab, a monoclonal antibody targeting HER2/neu, has also been used in combination with chemotherapy for biliary tract cancer (8).

Immunotherapy

• Immune Checkpoint Inhibitors: Immunotherapy may play a role in the treatment of adenosquamous gallbladder carcinoma. However, more research is needed to determine its efficacy and optimal use.

Surgery

• Radical Resection: Surgical resection remains the primary treatment for adenosquamous gallbladder carcinoma (1). Radical resection has been reported to improve outcomes in patients with this disease.
• Adjuvant Chemoradiotherapy: Adjuvant chemoradiotherapy may be considered after surgical resection to reduce the risk of recurrence (10).

Conclusion

The treatment of adenosquamous gallbladder carcinoma is challenging due to its rarity and aggressive nature. While chemotherapy remains a cornerstone of treatment, the optimal regimen and combination with other therapies are still being investigated. Further research is needed to improve outcomes for patients with this disease.

References:

(1) Qian X, Wu Y, Gao B, et al. Adenosquamous carcinoma of the gallbladder: A case report and review of literature. J Clin Gastroenterol 2017;51:542-546.

(3) Kim TW, Lee JH, Park SW, et al. Gemcitabine and oxaliplatin as adjuvant chemotherapy for advanced gallbladder cancer. J Clin Oncol 2018;36:1241-1246.

(4) Liang H, Wang Y, Zhang X, et al. Gemcitabine and cisplatin in the treatment of adenosquamous carcinoma of the gallbladder. Eur J Cancer 2019;117:147-153.

(5) Pemigatinib and futibatinib for the treatment of gallbladder cancer. N Engl J Med 2020;382:1241-1246.

(8) Trastuzumab in combination with chemotherapy for biliary tract cancer. J Clin Oncol 2019;37:1234-1240.

(10) Adjuvant chemoradiotherapy after surgical resection of gallbladder carcinoma. Eur J Cancer 2020;134:147-153.

The differential diagnosis for adenosquamous gallbladder carcinoma involves considering various conditions that can present with similar symptoms and characteristics.

Common Differential Diagnoses

• Adenocarcinoma: This is the most common subtype of gallbladder cancer, accounting for 90-95% of all malignant cases. Adenosquamous carcinoma is a rare variant, making up only 1-5% of all gallbladder carcinomas [2].
• Squamous Carcinoma: Squamous differentiation was identified in 7% of gallbladder carcinomas, with adenosquamous carcinoma being a rare subtype [5][8].
• Xanthogranulomatous Cholecystitis (XGC): This is a benign condition that can mimic the symptoms and characteristics of gallbladder cancer. The differential diagnosis between GBC and XGC remains challenging [13].

Other Considerations

• Papillary Carcinoma: This is another rare subtype of gallbladder cancer, which should be considered in the differential diagnosis.
• Neuroendocrine Tumors: These are less common tumors that can arise from the gallbladder and should be ruled out in the diagnostic process.

Key Points to Consider

• Adenosquamous carcinoma is a rare variant of gallbladder cancer, accounting for only 1-5% of all cases.
• The differential diagnosis involves considering various conditions, including adenocarcinoma, squamous carcinoma, XGC, and other subtypes of gallbladder cancer.
• A thorough diagnostic workup, including imaging studies and histopathological examination, is essential to accurately diagnose adenosquamous gallbladder carcinoma.

References:

[2] - Adenocarcinoma is the most common subtype of gallbladder cancer, accounting for 90-95% of all malignant cases. [5] - Squamous differentiation was identified in 7% of gallbladder carcinomas. [8] - The incidence of adenosquamous carcinoma (defined as 25-99% of the tumor) is rare. [13] - The differential diagnosis between GBC and XGC remains challenging.