USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 74-year-old woman comes to the clinic because of stomach pain for the past 6 months. It used to only occur after meals, but has gotten progressively more frequent and wakes her up at night. She also notes that she has lost 20-lb (9.1kg) in the past 3 months, and attributes this to a decreased appetite. Her current medications include atorvastatin and metformin. Her temperature is 38.1°C (100.6°F), pulse is 84/min, respirations are 12/min, and blood pressure is 136/84 mm Hg. Physical examination shows a cachectic appearing woman with yellow-colored skin. A non-tender mass is palpated in the right upper quadrant of the abdomen. Laboratory studies show a direct bilirubin of 3.5 mg/dL. Abdominal ultrasound is shown below. A cholecystectomy is performed and histologic examination shows a primary malignancy. Which of the following disorders is associated with the development of this patient's condition?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
When tissues are inflamed and irritated, they usually regenerate by cell division and laying down new protein. Tissues are mostly cells and protein after all.
Now each time a cell divides, there’s a chance that something will go wrong - a mistake will happen, and a normal gene will mutate.
If this happens with genes involved in cell replication itself, then you might have a cell that continues to divide out of control.
This is why tissues that are constantly subject to irritation and inflammation (especially tissues that are not used to it and typically don’t have as much cell division happening) are more likely to develop tumors, and the gallbladder’s no exception.
About three-quarters of patients that develop gallbladder cancer have cholesterol gallstones, and having gallstones in general is thought to increase the risk of gallbladder cancer significantly. Why is that though?
Well gallstones are known to induce inflammation of the glandular tissue along the gallbladder walls, also known as cholecystitis.
Over time, this constant state of inflammation and cell turnover increases the risk of a genetic mistakes and mutations, potentially leading to a carcinogenesis, or cancer formation.
If these cells do become carcinogenic, they proliferate and start forming a mass of these defective tumor cells in the glandular tissue of the gallbladder, which is why we can call it gallbladder adeno-carcinoma, or cancer of the glandular tissue.
With chronic inflammation of the gallbladder, the risk for carcinogenesis increases more and more over time, and that chronic inflammation of the gallbladder leads to calcification and fibrosis, a condition known as porcelain gallbladder.