P0091 - A Rare Case of Squamous Cell Carcinoma of the Bile Duct

Stefanie Gallagher, DO, MBe¹, Kyley Leroy, DO¹, Julianna Tantum, DO¹, Babak Etemad, MD^2
1Lankenau Medical Center, Wynnewood, PA; ²Lankenau Institute for Medical Research, Wynnewood, PA

Introduction: Biliary tract squamous cell carcinoma (SCC) is exceptionally rare. We present a case of an elderly male with recurrent admissions for cholecystitis and ascending cholangitis who was subsequently diagnosed with biliary SCC.

Case Description/Methods: A 76-year-old male with history of colon cancer s/p curative resection presents initially with cholecystitis, treated with cholecystostomy tube and antibiotics with eventual tube removal. He re-presented with ascending cholangitis; tube was replaced. MRI showed normal contour and caliber of intra and extra hepatic biliary tree and miniscule layered stones in distal common bile duct (CBD) without biliary ductal dilatation. ERCP demonstrated occluded cystic duct and plastic stent was left. He underwent cholecystectomy with pathology showing marked acute and chronic cholecystitis. He re-presented with cholangitis 2 months later; ultrasound with new intra and extra hepatic ductal dilatation and ERCP showed narrowing of CBD in the region of clip placement, concerning for extrinsic compression or narrowing due to ischemia. Brushings revealed atypical glandular and squamous cells in background of acute inflammation. Metallic stent was left. He presents 1 month later with jaundice. Vitals stable. Labs: AST 242, ALT 263, AP 1016, total bilirubin 9.5 (DB 6.5), WBC 8.88. ERCP demonstrated a 2-cm area of narrowing just below the bifurcation suspicious for granulation tissue or neoplasia (Figure 1). Pathology showed evidence of invasive SCC and associated glandular atypia. Tumor cells positive for p40 (confirming squamous differentiation) and CK19 and negative for CK7 and CK20, associated glandular atypia, noted to be reactive or neoplastic. He declined any treatment.

Discussion: SCC and adenosquamous carcinoma of the extra hepatic bile duct are extremely rare. The diagnosis of adenosquamous carcinoma is made when SCC consists of >25% of tumor component. The pathogenesis is unknown but likely involves normal biliary columnar epithelium undergoing squamous metaplasia with eventual dysplasia, after recurrent inflammation. Patients with history of hepatolithiasis, recurrent pyogenic cholangitis or clonorchiasis may be predisposed. The overall prognosis is poor. Treatment options include surgical resection with or without chemoradiation.







Reference:




1. Kang M,Kim NR,Chung DH, Cho HY, Park YH.SCC of the Extrahepatic Common Hepatic Duct.J Pathol Transl Med. 2019;53(2):112-118.doi:10.4132/jptm.2018.09.03


Figure: 2 cm area of narrowing just below the bifurcation, with small distance between upper end of stricture and bifurcation, and diffusely dilated left and right main ducts, demonstrating the area of the lesion.


Disclosures:
Stefanie Gallagher indicated no relevant financial relationships.
Kyley Leroy indicated no relevant financial relationships.
Julianna Tantum indicated no relevant financial relationships.
Babak Etemad indicated no relevant financial relationships.


Stefanie Gallagher, DO, MBe¹, Kyley Leroy, DO¹, Julianna Tantum, DO¹, Babak Etemad, MD². P0091 - A Rare Case of Squamous Cell Carcinoma of the Bile Duct, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.