A porcelain gallbladder and a rapid tumor dissemination

Abstract

IntroductionPorcelain gallbladder is a very rare entity that consists of a calcification of the gallbladder wall, and is associated with carcinoma in 12.5–62% of patients, although recent studies suggest weaker association.Case reportWe describe an 80-year-old woman who presented with colicky abdominal pain in the right upper quadrant, radiating to the back and associated with vomiting. Physical examination revealed jaundice, murphy's sign was negative.Hepatic-biliary tract ultrasound revealed porcelain gallbladder, she was referred to the surgical team for a scheduled cholecystectomy. A month later, she presented diffuse abdominal pain. Imaging studies showed a disseminated process affecting liver's segments, capsule, and hilum; and lungs. An aggressive surgical treatment was dismissed, and was referred to the oncology department.DiscussionThere is controversy in the harboring risk of malignancy of the porcelain gallbladder. While it seems that the current data points towards a lower risk of degeneration, it is also demonstrated that patients with gallbladder wall calcifications are indeed statistically at risk of gallbladder cancer. Laparoscopic cholecystectomy has become a safe and efficient approach recommended for patients with gallbladder symptoms directly related or unrelated to gallbladder wall calcifications. In this case, a pathological gallbladder, very quickly evolved into an inoperable tumor with a poor prognosis.ConclusionThis report heightens that with US evidence of porcelain gallbladder, an urgent CT scan should be carried out to assess an underlying malignancy, and a simple cholecystectomy should be done urgently rather than on a routine elective list to prevent possible malignant change if possible.

Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review

“…The radiographic findings of calcified gallbladders vary according to the location, extent and degree of calcification. Less intense calcification is difficult to identify with plain radiography, but more diffuse severe calcification appears as rounded or curvilinear findings, as reported by a case report [22]. Recently, the frequent use of ultrasonography in patients with abdominal problems has led to earlier detection of PGB.…”

“…PGB cases may be detected incidentally on abdominal imaging. Plain abdominal radiographs may show rim-like calcifications in the gallbladder wall [22]. Imaging modalities for PGB include ultrasound [23] and abdominal computed tomography (CT) scans [24], and diffusion-weighted magnetic resonance imaging has been reported to be effective in differential diagnosis [25].…”

Porcelain Gallbladder: Decoding the malignant truth

“…5 Since then, several reports have emerged. [1][2][3][4][5][6][9][10][11][12][14][15][16][17][18] In one study of 4,271 cholecystectomy specimens collected between 1922-1956, adenocarcinomas were noted in two out of 16 calcified gallbladders (12.5%). 5 In another report from Argentina, CaGB was detected in 16 out of 26 calcified gallbladder specimens (61.5%).…”

CT Imaging Findings of Porcelain Gallbladder and Epiploic Appendagitis: Two Rare Abdominal Pathologies in an Asymptomatic Patient

“…However, gallbladder wall thickening with either mucosal or intramural calcification are chronic events that usually present with associated gallstones and biliary colic [4]. Similar to EA, the true incidence of PG is likely underreported with current estimates being 0.06-0.08% of routine cholecystectomy specimens [5]. Prior investigations found a strong association between PG and gallbladder carcinoma, yet, new evidence suggests that the relationship is markedly lower than previously calculated (7-61.5% versus 2-3%), and not all presentations require cholecystectomy [6].…”