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Metastasis as initial presentation of squamous cell carcinoma of gallbladder: A rare clinical entity

A 40‐year‐old female presented with the chief complaints of fever for 3 months and intermittent pain in abdomen for 2 months. On examination, the patient was middle‐aged female with average built. Clinically, the patient had pallor, icterus, edema feet, and ascites. Pulse rate was 100/min and blood pressure was 110/80 mmHg. Chest and cardiovascular system examination was normal. Per abdomen examination was soft, tenderness was present in the right hypochondrium, and globular mass was palpable in the right hypochondrium. Per rectum examination was normal. Laboratory investigation was suggestive of low hemoglobin (8.4 g/dl), raised total (17.87 mg/dl) and direct bilirubin (14.9 mg/dl), raised alkaline phosphatase (896.3 IU/L), and decreased albumin (2.45 mg/ dl). Ultrasound abdomen showed a mass in gallbladder fossa with liver metastasis with dilatation of intrahepatic biliary radicles (IHBR). In view of this presentation, percutaneous transhepatic biliary drainage (PTBD) was done for making a conduit for bile. Biopsy from gallbladder fossa mass was suggestive of SCC [Figure 1]. In view of locally advanced features and deranged bilirubin, after PTBD, single‐agent gemcitabine was given to the patient. At present, the patient is still undergoing chemotherapy at our center and is doing well. At present, total bilirubin had come down to 2.6 mg/dl with direct fraction being 1.98 mg/dl. Furthermore, international normalized ratio had decreased to 1.5 mg/ dl. Being inoperable, the patient was given single‐agent gemcitabine. After receiving two cycles of chemotherapy, bilirubin had declined and the appetite and performance status had improved. After three cycles of chemotherapy, we planned to evaluate the patient to analyze the response to chemotherapy.