S3649 A 7-Month Delay in Cholecystectomy: Progression of a Gallbladder Mass to Stage T3 Cancer

Introduction: Delay in cholecystectomy for gallbladder masses significantly increases the risk of carcinoma; timely removal is essential to prevent malignant transformation and improve patient prognosis. Case Description/Methods: A 78-year-old woman with a history of chronic obstructive pulmonary disease on 4 L/min of baseline oxygen, hypothyroidism, extensive cholelithiasis, and a suspected gallbladder neoplasm on imaging—who had received a Wallflex metal stent 7 months earlier for a benign distal common bile duct stricture—was lost to follow-up after an outpatient cholecystectomy was recommended. She re-presented with sepsis and altered mental status: fever (104°F), tachypnea, tachycardia, leukocytosis (26,000/µL), and cholestatic features (ALP 430 U/L; total bilirubin 4.3 mg/dL). Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated duodenal compression by a distended gallbladder and occlusion of the stent by debris, without an identifiable mass. Contrast-enhanced computed tomography confirmed a hydropic gallbladder with gallstones. A magnetic resonance imaging performed 7 months earlier had shown a 4 × 3 cm ill-defined lesion at the gallbladder fundus, with focal narrowing of the Phrygian cap and associated enhancement. She underwent laparoscopic cholecystectomy and repair of a newly identified cholecystoduodenal fistula. Pathology revealed a moderately differentiated adenocarcinoma (stage T3) in the fundus, with possible adenocarcinoma at the fistula site. She was not a candidate for adjuvant chemotherapy due to poor performance status and multiple comorbidities. Discussion: Gallbladder polyps ≥1 cm have reported malignancy rates of 6%–8.5%; current guidelines recommend cholecystectomy for lesions ≥1 cm or in symptomatic patients. Fundal lesions on magnetic resonance imaging warrant expedited surgical evaluation, particularly in high-risk individuals. This case illustrates how noncompliance with outpatient follow-up and delayed intervention allowed progression to stage T3 adenocarcinoma.