背景:单纯的胆囊鳞状细胞癌(SCC)是一种罕见的恶性胆道肿瘤,主要存在于胆囊的身体和颈部。然而,它在胆囊管中的发生更为罕见。鉴于其稀有性,目前尚无关于胆囊单纯SCC治疗的既定指南或共识.我们报告了一例源自胆囊管的SCC的不寻常病例,目的是提供对此类恶性肿瘤的治疗方法的见解。
方法:一名男性患者因急性胆囊炎就诊。出乎意料的是,影像学检查显示胆囊恶性肿瘤。
方法:术后病理检查证实胆囊管SCC。
方法:尽管胆红素水平升高,我们能够排除Hilar的参与,能够进行根治性肿瘤切除。术中,我们发现肿瘤位于胆囊管,与侵入邻近器官的可能性很高有关的部位。肿瘤表现出主要的外生生长模式,这促使我们避免扩大切除范围,从而在完全切除肿瘤和手术创伤之间取得平衡。我们进行肝楔形切除术只是为了确保阴性切除边缘,同时最大程度地保留解剖结构。术后恢复迅速且简单。病理检查证实为单纯SCC,这导致我们开始了nab-紫杉醇和顺铂的治疗方案,已知在其他器官SCC中有效。值得注意的是,患者经历了罕见且严重的治疗后心血管事件.因此,我们将患者改为吉西他滨和顺铂的化疗方案,最终产生积极的临床结果。
结果:术后1年内未观察到肿瘤复发的证据。
结论:对于罕见肿瘤如胆囊鳞状细胞癌的诊断和治疗策略,应根据其独特的特征进行精心定制,以优化术后患者的预后。
BACKGROUND: Pure squamous cell carcinoma (SCC) of the gallbladder is a rare malignant biliary tract tumor predominantly found in the body and neck of the gallbladder. However, its occurrence in the cystic duct is even rarer. Given its rarity, no established guidelines or consensus currently exist regarding the treatment of pure SCC of the gallbladder. We report an unusual case of SCC originating from the cystic duct with the intent of providing insights into the therapeutic approach for this type of malignancy.
METHODS: A male patient presented to our hospital with acute cholecystitis. Unexpectedly, imaging revealed gallbladder malignancy.
METHODS: Pathologic examination after surgery confirmed SCC of the cystic duct.
METHODS: Despite elevated bilirubin levels, we were able to exclude hilar involvement, enabling radical tumor resection. Intraoperatively, we discovered that the tumor was located in the cystic duct, a site associated with a high likelihood of invasion into neighboring organs. The tumor demonstrated a predominantly exophytic growth pattern, which prompted us to refrain from extending the resection range, thereby striking a balance between complete tumor removal and surgical trauma. We performed liver wedge resection only to ensure a negative resection margin while preserving the anatomical structure to the greatest extent possible. Postoperative recovery was rapid and uncomplicated. Pathological examination confirmed pure SCC, which led us to initiate a regimen of nab-paclitaxel and cisplatin, which is known to be effective in other organ SCCs. Remarkably, the patient experienced a rare and severe posttreatment cardiovascular event. Consequently, we switched the patient to a chemotherapy regimen of gemcitabine and cisplatin, which ultimately yielded positive clinical outcomes.
RESULTS: no evidence of tumor recurrence was observed within 1 year after surgery.
CONCLUSIONS: The diagnosis and therapeutic strategy for rare tumors such as gallbladder SCC should be meticulously tailored based on their unique characteristics to optimize postoperative patient outcomes.