Metastatic Squamous Cell Carcinoma to the Gallbladder Presenting as a Diagnostic and Surgical Challenge
Bibliographic record
Abstract
Metastatic spread to the gallbladder is exceedingly rare, representing less than 5% of all gallbladder malignancies, with secondary involvement from head and neck squamous cell carcinoma (SCC) being exceptionally uncommon. We present the case of a 68-year-old male with recurrent metastatic head and neck SCC who arrived with right upper-quadrant pain, nausea, and vomiting. Imaging demonstrated gallbladder distension and wall thickening without cholelithiasis, and subsequent hepatobiliary iminodiacetic acid (HIDA) scanning and magnetic resonance cholangiopancreatography (MRCP) findings supported a diagnosis of acute cholecystitis with cystic duct obstruction. The patient underwent robotic cholecystectomy, during which indocyanine green (ICG) fluorescence cholangiography was utilized to delineate biliary anatomy in the setting of severe inflammation. Intraoperative evaluation revealed a gangrenous gallbladder with cystic duct necrosis. Histopathologic examination demonstrated a 1.5 cm epithelioid/squamoid carcinoma consistent with metastatic SCC, with positive cystic duct margins. The postoperative course was uneventful. Metastatic SCC to the gallbladder is often indistinguishable from benign inflammatory disease on imaging and is commonly diagnosed only after cholecystectomy. While prognosis is largely determined by the burden of systemic disease, surgical excision of isolated lesions may provide symptomatic relief and facilitate diagnosis. This case highlights the importance of considering metastatic disease in patients with a history of malignancy who present with cholecystitis-like symptoms and underscores the value of minimally invasive cholecystectomy in achieving safe management and diagnostic clarity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".