USMLE® Step 1 style questions USMLE
A 65-year-old woman comes to a follow-up appointment following hospitalization due to diverticulitis. Since then, she has been recovering well and has no complaints. Medical history is significant for cholelithiasis, hypercholesterolemia, diverticulitis and constipation. Medications include statins, multivitamins, and supplemental fiber. She does not smoke, drink alcohol, or use illicit drugs. On physical examination, the abdomen is soft and nontender, and bowel sounds are present. A CT obtained at the recent hospitalization is shown below:
Reproduced from: Wikimedia Commons
This patient is at risk of developing which of the following complications?
Gallbladder cancer exam links
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.
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