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Volume 61
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10.3390/medicina61030452
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Case Report

Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder—A Complex Relationship with a Difficult Management in the Acute Setting

by
Matteo Zanchetta
1,*,
Gian Luigi Adani
2,
Giorgio Micheletti
2,
Gianmario Edoardo Poto
1,
Stefania Angela Piccioni
1,
Ludovico Carbone
1,
Ilaria Monteleone
3,
Marta Sandini
1,
Daniele Marrelli
1 and
Natale Calomino
2
1
Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
2
Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
3
Diagnostic Imaging Unit, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(3), 452; https://doi.org/10.3390/medicina61030452
Submission received: 26 January 2025 / Revised: 23 February 2025 / Accepted: 4 March 2025 / Published: 5 March 2025
(This article belongs to the Section Surgery)
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Abstract

The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC.
Keywords: cholelithiasis; gallbladder carcinoma; squamous cell carcinoma; diabetes mellitus; gallstones; peritonitis; acute cholecystitis; tissue hypoxia; emergency surgery; carcinogenic microenvironment cholelithiasis; gallbladder carcinoma; squamous cell carcinoma; diabetes mellitus; gallstones; peritonitis; acute cholecystitis; tissue hypoxia; emergency surgery; carcinogenic microenvironment

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MDPI and ACS Style

Zanchetta, M.; Adani, G.L.; Micheletti, G.; Poto, G.E.; Piccioni, S.A.; Carbone, L.; Monteleone, I.; Sandini, M.; Marrelli, D.; Calomino, N. Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder—A Complex Relationship with a Difficult Management in the Acute Setting. Medicina 2025, 61, 452. https://doi.org/10.3390/medicina61030452

AMA Style

Zanchetta M, Adani GL, Micheletti G, Poto GE, Piccioni SA, Carbone L, Monteleone I, Sandini M, Marrelli D, Calomino N. Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder—A Complex Relationship with a Difficult Management in the Acute Setting. Medicina. 2025; 61(3):452. https://doi.org/10.3390/medicina61030452

Chicago/Turabian Style

Zanchetta, Matteo, Gian Luigi Adani, Giorgio Micheletti, Gianmario Edoardo Poto, Stefania Angela Piccioni, Ludovico Carbone, Ilaria Monteleone, Marta Sandini, Daniele Marrelli, and Natale Calomino. 2025. "Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder—A Complex Relationship with a Difficult Management in the Acute Setting" Medicina 61, no. 3: 452. https://doi.org/10.3390/medicina61030452

APA Style

Zanchetta, M., Adani, G. L., Micheletti, G., Poto, G. E., Piccioni, S. A., Carbone, L., Monteleone, I., Sandini, M., Marrelli, D., & Calomino, N. (2025). Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder—A Complex Relationship with a Difficult Management in the Acute Setting. Medicina, 61(3), 452. https://doi.org/10.3390/medicina61030452

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