Acute Cholecystitis as a Diagnosis of Mucinous Cystic Neoplasia of the Gallbladder. A Literature Review

Abstract

Purpose: Mucinous cystic neoplasms (MCNs) of the gallbladder are extremely rare, benign, unilocular or multilocular cystic tumors that contain septations. We present a case diagnosed incidentally after emergency cholecystectomy for acute cholecystitis. Method: 69-year-old woman with epigastric pain of 24 hours of evolution associated with nausea and fever. No jaundice. 14,000 leukocytes, CRP: 33. Normal bilirubin, gamma-GT, and alkaline phosphatase. Positive Murphy's sign. Abdominal ultrasound: acute cholecystitis. Surgical treatment: laparoscopic cholecystectomy, showing acute edematous cholecystitis. No complications in the postoperative period. AP: mucinous cystic neoplasm (MCN) with low-grade dysplasia. Results and conclusions: MCNs of the gallbladder are rare, and no established guidelines for appropriate management have been developed. It´s benign cystic proliferations of the hepatobiliary epithelium. Lesions originate in the liver in 85% of cases and affect women more frequently, with a mean age at presentation of 45 years. Its origin remains unclear. Previous studies have hypothesized that originate from ectopic remnants of embryonal gallbladder tissue and aberrant hamartomatous bile ducts. Discrepancies across the literature exist regarding the malignant potential. Some authors believe that approximately 13% of cystadenomas have dysplastic changes that can progress to a malignant form. If suspected, ultrasound or CT-guided fine needle aspiration for biopsy is generally not recommended as it increases the chances of tumor spread in the peritoneal cavity. The only consistent consensus across the literature is that all suspected MCNs originating in the gallbladder should be imaged, surgically removed, and evaluated under the microscope to determine the nature of the disease.