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Porcelain gallbladder

INTRODUCTION

Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis, characterized by intramural calcification of the gallbladder wall [1]. The term "porcelain gallbladder" is used to describe the bluish discoloration and brittle consistency of the gallbladder wall seen in this condition [2]. The diagnosis is usually suggested by an abdominal radiograph revealing an incidental calcified lesion in the region of the gallbladder. Patients with a porcelain gallbladder are often asymptomatic, but are at increased risk for the development of gallbladder carcinoma, which has a poor prognosis [2]. Thus, the possibility of a porcelain gallbladder should always be considered in the differential diagnosis of calcified right upper quadrant abdominal lesions. (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis".)

EPIDEMIOLOGY AND RISK OF MALIGNANCY

The incidence of a calcified gallbladder at autopsy ranges from 0.06 to 0.08 percent [3]. It is more common in females than in males, with a ratio of 5:1 [4]. The mean age at presentation varies from 38 to 70 years [4]. The risk of gallbladder cancer in patients with porcelain gallbladder is unclear, with reported rates ranging from 0 to 62 percent [2,3,5-8].

In a systematic review of eight series that included 60,665 patients who underwent cholecystectomy, 140 (0.2 percent) had porcelain gallbladder [7]. Of those with porcelain gallbladder, 21 (15 percent) had gallbladder cancer. However, the authors note that the high rates of gallbladder cancer were seen primarily in older studies. Among the 85 patients with porcelain gallbladder from studies reported between 2001 and 2011, gallbladder cancer was seen in 2 (2.3 percent; range 0 to 5 percent for the individual studies).

The pattern of calcification may be particularly important in predicting which patients are at increased risk for gallbladder cancer. Patients with selective mucosal calcification or incomplete calcification of the gallbladder wall appear to be at higher risk for gallbladder cancer compared with those in whom the gallbladder wall is completely calcified (complete type) (see 'Ultrasonography' below):

In a series of 44 patients with gallbladder calcification who underwent cholecystectomy, 17 had complete intramural calcification, and 27 had selective (incomplete) mucosal calcification [6]. Gallbladder cancer was present in two of the patients with selective mucosal calcification (7 percent) and in none of the patients with complete calcification.

        

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Literature review current through: Jul 2014. | This topic last updated: Jun 5, 2014.
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References
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