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  Table of Contents    
LETTER TO EDITOR  
Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 182-183
Primary squamous cell carcinoma of the common bile duct


1 Department of Pathology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning, China
2 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yuanjiagang Youyi Road, Chongqing, China

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Date of Submission03-Jun-2020
Date of Decision09-Jul-2020
Date of Acceptance28-Oct-2020
Date of Web Publication7-Jun-2021
 

How to cite this article:
Zhong L, Qi W, Tao F, Zhang L, Kong J. Primary squamous cell carcinoma of the common bile duct. Indian J Pathol Microbiol 2021;64:182-3

How to cite this URL:
Zhong L, Qi W, Tao F, Zhang L, Kong J. Primary squamous cell carcinoma of the common bile duct. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Jun 13];64:182-3. Available from: https://www.ijpmonline.org/text.asp?2021/64/5/182/317917




Dear Editor,

The most common malignant tumors of the biliary tree are adenocarcinomas, and primary squamous cell carcinoma (SCC) of the biliary tract is a rare tumor. The incidence of SCC in the extrahepatic bile duct is less than 1.4%.[1] Cabot reported the first case of SCC in the bile duct.[2] Here, we report a rare case of primary SCC of the common bile duct (CBD).

A 76-year-old Chinese man complained of jaundice, dark urine, and clay-colored stools with epigastric pain. His laboratory test results were as follows: Total bilirubin (312.1 μmol/L; normal range: 3–22 μmol/L), direct fraction (2.0 mg/dL; normal range: 0.1–0.6 mg/dL), alkaline phosphatase (331 U/L; normal range: 45–132 U/L), γ-glutamyl transpeptidase (429 U/L; normal range: 12–58 U/L), aspartate aminotransferase (106 U/L; normal range: 15–46 U/L), and alanine aminotransferase (88 IU/L; normal range: 13–69 U/L), while the level of cancer antigen 19-9 (CA19-9) was 728.5 U/mL (normal range: 0–27 U/mL). Magnetic resonance imaging (MRI) showed a low signal intensity area in a T2-weighted image [Figure 1]a. Magnetic resonance cholangiopancreatography (MRCP) showed a low signal intensity area in the middle CBD [Figure 1]b.
Figure 1: (a) MRI showed a low signal intensity area in a T2-weighted image (white arrow). (b) Magnetic resonance cholangiopancreatography showed a low signal intensity area in the middle CBD (white arrow)

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He underwent Whipple's pancreaticoduodenectomy. At surgery, a well-defined mass measuring 30 × 15 × 15 mm was found in the middle CBD. The cut surface was solid, irregular, and gray-white with no apparent hemorrhagic or necrotic [Figure 2]. The liver and gall bladder were normal and there were no signs of ascites or lymphadenopathy.
Figure 2: Macroscopically, a well-defined mass measuring 30 × 15 × 15 mm was found in the middle CBD. The cut surface was solid, irregular, and gray-white with no apparent hemorrhagic or necrotic

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Histopathological analysis indicated a poorly moderately differentiated SCC. Intercellular bridges and necrosis were seen in tumor cells with no apparent keratinization [Figure 3]a. Parts of glandular epithelium showed metaplastic changes to squamous epithelium with atypical hyperplasia [Figure 3]b. There was no lymph node metastasis. Tumor cells were positive for CK5/6 and p63 and negative for CK20 [Figure 3]c and [Figure 3]d. On the basis of the morphology and IHC, a diagnosis of poorly-moderately differentiated SCC of the middle CBD was determined. The patient had a good clinical course and was discharged 25 days after surgery. The patient refused additional chemoradiotherapy and was out of contact six months after discharge.
Figure 3: Microscopic findings (a) sheets and islands of atypical polygonal cells show moderately differentiated dyskeratotic squamous cells with keratin pearls infiltrating to the fibromuscular layer. There is no mucin production or ductal formation. (b) Surface epithelium shows a transition from unilayered cuboidal to squamous epithelium (black arrow). Immunohistochemically, the tumor cells are positive for CK5/6 (c) and p63 (d)

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There are many differing opinions regarding the mechanisms of SCC in the biliary tree. Metaplastic squamous epithelium of glandular tissues, primary sclerosing cholangitis, Caroli disease, choledochal cyst, ectopic squamous epithelium, and ascariasis may be causative.[3] Knudsen et al. revealed genomic alterations including FBXW7, CREBBP, CTCF, FAT1, MAGI2, MLL2, and NOTCH1 via a next generation sequencing assay covering 315 tumor-related genes in the SCC of extrahepatic bile ducts.[4]

To date, surgical resection remains the recommended treatment for biliary SCC. The recommended chemotherapy is GEMOX (gemcitabine plus oxaliplatin) or GP (gemcitabine plus cisplatin). Chemotherapy with docetaxel plus cisplatin plus 5-FU(5-fluorouracil) therapy or S-1 plus cisplatin therapy may be helpful.[5] EGFR, v-EGFR, Raf and Her-2-targeted therapy have shown benefit for other cancer types, and their effects in SCC are being investigated.

The mechanisms and treatment after surgical resection of the SCC from the biliary tree are unclear. Thus, more cases and longer follow-up will be necessary for understand the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Funakawa T, Fujishiro N, Kuno N, Kobayashi S, Kimoto E, Suzuki K. Squamous cell carcinoma of the extrahepatic bile duct. Ryoikibetsu Shokogun Shirizu 1996;61-3.  Back to cited text no. 1
    
2.
Cabot RC. Case records of the Massachusetts general hospital: Case 16261. N Eng J Med 1930;202:1260-2.  Back to cited text no. 2
    
3.
Sewkani A, Kapoor S, Sharma S, Naik S, Juneja M, Jain A, et al. Squamous cell carcinoma of the distal common bile duct. JOP 2005;6:162-5.  Back to cited text no. 3
    
4.
Knudsen KN, Mortensen MB, Detlefsen S. Squamous cell carcinoma of the common bile duct: A case report with genomic profiling. Pathol Int 2019;69:427-31.  Back to cited text no. 4
    
5.
Nishiguchi R, Kim DH, Honda M, Sakamoto T. Squamous cell carcinoma of the extrahepatic bile duct with metachronous para-aortic lymph node metastasis successfully treated with S-1 plus cisplatin. BMJ Case Rep 2016;2016:bcr2016218177.  Back to cited text no. 5
    

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Correspondence Address:
Jienan Kong
Department of Pathology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian - 116011, Liaoning
China
Lizhi Zhang
Department of Pathology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian - 116011, Liaoning
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_633_20

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  [Figure 1], [Figure 2], [Figure 3]



 

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