Porcelain gallbladder: Difference between revisions
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{{Infobox medical condition (new) |
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|name = Porcelain gallbladder |
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|synonym = Calcified gallbladder |
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|image = Porcelain gallbladder.png |
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|caption = Porcelain gallbladder on X-ray |
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'''Porcelain gallbladder''' is a [[calcification]] of the [[gallbladder]] believed to be brought on by excessive [[gallstone]]s, although the exact [[etiology|cause]] is not clear. As with gallstone disease in general, this condition occurs |
'''Porcelain gallbladder''' is a [[calcification]] of the [[gallbladder]] believed to be brought on by excessive [[gallstone]]s, although the exact [[etiology|cause]] is not clear. As with gallstone disease in general, this condition occurs mostly in overweight female patients of middle age. It is a morphological variant of chronic cholecystitis. Inflammatory scarring of the wall, combined with dystrophic calcification within the wall transforms the gallbladder into a porcelain-like vessel. Removal of the gallbladder ([[cholecystectomy]]) is the recommended treatment. |
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==Symptoms and signs== |
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| ⚫ | The assertion that porcelain gallbladder increases the incidence of gallbladder cancer is widely taught in medical schools but is based on studies from 1931 and 1962. |
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===Association with cancer=== |
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There are two types of wall calcification: diffuse intramural calcification in the muscular layer, and selective mucosal calcification - which poses a significant risk for cancer in 7%, in comparison with the first type, which is not premalignant.<ref>http://www.eurorad.org/eurorad/case.php?id=9373</ref> |
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| ⚫ | The assertion that porcelain gallbladder increases the incidence of gallbladder cancer is widely taught in medical schools but is based on studies from 1931 and 1962.<ref name="pmid11206901" /> A prominent study aid for surgical residents even states that the risk of cancer in a porcelain gallbladder is 15%.<ref>{{cite book|last1=Fiser|first1=Steven|title=The ABSITE Review|date=2013|publisher=LWW|isbn=978-1451186901|edition=4th}}</ref> The precise nature of the association between gallbladder cancer and porcelain gallbladder is uncertain. Two articles published in 2001 examined the association between cancer of the gallbladder and calcified gallbladder. The first study reviewed 10,741 cholecystectomies and found that the 88 patients with gallbladder cancer did not have calcified gallbladders while the 15 patients with porcelain gallbladders did not have gallbladder cancer.<ref name=pmid11206901>{{cite journal |pmid=11206901 |year=2001 |last1=Towfigh |first1=S |last2=McFadden |first2=DW |last3=Cortina |first3=GR |last4=Thompson Jr |first4=JE |last5=Tompkins |first5=RK |last6=Chandler |first6=C |last7=Hines |first7=OJ |title=Porcelain gallbladder is not associated with gallbladder carcinoma |volume=67 |issue=1 |pages=7–10 |journal=The American Surgeon}}</ref> The second study reviewed 25,900 gallbladder specimens and found 150 patients with cancer and 44 patients with calcified gallbladders of two types (intramural calcification and selective mucosal calcification).<ref name="pmid11391368" /> The selective mucosal calcification group showed a 7% incidence of cancer with a significant odds ratio of 13.89.<ref name=pmid11391368>{{cite journal |doi=10.1067/msy.2001.113888 |title=Carcinoma in the porcelain gallbladder: A relationship revisited |year=2001 |last1=Stephen |first1=Antonia E. |last2=Berger |first2=David L. |journal=Surgery |volume=129 |issue=6 |pages=699–703 |pmid=11391368}}</ref> |
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| ⚫ | An article published in 2013 reviewed 111 studies and found 340 patients with gallbladder wall calcification showed a 21% overall rate of gallbladder malignancy; however, when studies with obvious selection bias were excluded the rate of gallbladder malignancy fell to 6%.<ref>{{cite journal|last=Schnelldorfer|first=Thomas|title=Porcelain Gallbladder: A Benign Process or Concern for Malignancy?|journal=Journal of Gastrointestinal Surgery|date=June 2013|volume=17|issue=6|pages=1161–1168|doi=10.1007/s11605-013-2170-0|pmid=23423431}}</ref> Comparatively, a matched cohort without gallbladder calcification showed a 1% rate of gallbladder malignancy. |
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==Symptoms== |
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==Diagnosis== |
==Diagnosis== |
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Abdominal [[radiography]] (X-ray), abdominal [[ultrasound]] or [[X-ray computed tomography|CT scan]]. |
Abdominal [[radiography]] (X-ray), abdominal [[ultrasound]] or [[X-ray computed tomography|CT scan]].{{cn|date=March 2022}} |
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==Treatment== |
==Treatment== |
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Due to the increased risk for gallbladder cancer, the recommended treatment is [[cholecystectomy]] which usually includes pre-operative or intra-operative imaging of the biliary tree. Cholecystectomy may be performed via an open incision or via laparoscopic methods, but gallbladder anatomy and consistency may complicate the operation.<ref>{{cite journal|last=Tomioka|first=T.|author2=Tajima, Y. |author3=Inoue, K. |author4=Onizuka, S. |author5=Ikematsu, Y. |author6= Kanematsu, T. |title=Laparoscopic Cholecystectomy Is a Safe Procedure for the Treatment of Porcelain Gallbladder|journal=Endoscopy|date=March 1997|volume=29|issue= |
Due to the increased risk for gallbladder cancer, the recommended treatment is [[cholecystectomy]] which usually includes pre-operative or intra-operative imaging of the biliary tree. Cholecystectomy may be performed via an open incision or via laparoscopic methods, but gallbladder anatomy and consistency may complicate the operation.<ref>{{cite journal|last=Tomioka|first=T.|author2=Tajima, Y. |author3=Inoue, K. |author4=Onizuka, S. |author5=Ikematsu, Y. |author6= Kanematsu, T. |title=Laparoscopic Cholecystectomy Is a Safe Procedure for the Treatment of Porcelain Gallbladder|journal=Endoscopy|date=March 1997|volume=29|issue=3|pages=225|doi=10.1055/s-2007-1004172|pmid=9201480|doi-access=free}}</ref> |
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Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients<ref>{{Cite journal|last=Machado|first=Norman O.|date=November 2016|title=Porcelain Gallbladder|journal=Sultan Qaboos University Medical Journal|volume=16|issue=4|pages=e416–e421|doi=10.18295/squmj.2016.16.04.003|issn=2075-051X|pmc=5135451|pmid=28003886}}</ref> |
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==References== |
==References== |
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{{reflist}} |
{{reflist}} |
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Fiser, Steven. ''The Absite Review.'' 4th ed., LWW, 2013. |
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==External links== |
==External links== |
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| ICD10 = {{ICD10|K82.8}} |
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| ICD9 = {{ICD9|575.8}} |
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* [http://www.emedicine.com/radio/topic569.htm eMedicine.com] – Porcelain Gallbladder by Ali Nawaz Khan and Margaret Aird |
* [http://www.emedicine.com/radio/topic569.htm eMedicine.com] – Porcelain Gallbladder by Ali Nawaz Khan and Margaret Aird |
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{{Digestive system diseases}} |
{{Digestive system diseases}} |
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Latest revision as of 05:03, 29 November 2023
| Porcelain gallbladder | |
|---|---|
| Other names | Calcified gallbladder |
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| Porcelain gallbladder on X-ray | |
| Specialty | Gastroenterology, hepatology  |
Porcelain gallbladder is a calcification of the gallbladder believed to be brought on by excessive gallstones, although the exact cause is not clear. As with gallstone disease in general, this condition occurs mostly in overweight female patients of middle age. It is a morphological variant of chronic cholecystitis. Inflammatory scarring of the wall, combined with dystrophic calcification within the wall transforms the gallbladder into a porcelain-like vessel. Removal of the gallbladder (cholecystectomy) is the recommended treatment.
Symptoms and signs
[edit]Symptoms are similar to gallstones and can include abdominal pain (especially after eating), jaundice, and vomiting. Porcelain gallbladder can also be asymptomatic and discovered on imaging obtained for a different reason.
Association with cancer
[edit]The assertion that porcelain gallbladder increases the incidence of gallbladder cancer is widely taught in medical schools but is based on studies from 1931 and 1962.[1] A prominent study aid for surgical residents even states that the risk of cancer in a porcelain gallbladder is 15%.[2] The precise nature of the association between gallbladder cancer and porcelain gallbladder is uncertain. Two articles published in 2001 examined the association between cancer of the gallbladder and calcified gallbladder. The first study reviewed 10,741 cholecystectomies and found that the 88 patients with gallbladder cancer did not have calcified gallbladders while the 15 patients with porcelain gallbladders did not have gallbladder cancer.[1] The second study reviewed 25,900 gallbladder specimens and found 150 patients with cancer and 44 patients with calcified gallbladders of two types (intramural calcification and selective mucosal calcification).[3] The selective mucosal calcification group showed a 7% incidence of cancer with a significant odds ratio of 13.89.[3]
An article published in 2013 reviewed 111 studies and found 340 patients with gallbladder wall calcification showed a 21% overall rate of gallbladder malignancy; however, when studies with obvious selection bias were excluded the rate of gallbladder malignancy fell to 6%.[4] Comparatively, a matched cohort without gallbladder calcification showed a 1% rate of gallbladder malignancy.
Diagnosis
[edit]Abdominal radiography (X-ray), abdominal ultrasound or CT scan.[citation needed]
Treatment
[edit]Due to the increased risk for gallbladder cancer, the recommended treatment is cholecystectomy which usually includes pre-operative or intra-operative imaging of the biliary tree. Cholecystectomy may be performed via an open incision or via laparoscopic methods, but gallbladder anatomy and consistency may complicate the operation.[5]
Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients[6]
References
[edit]- ^ a b Towfigh, S; McFadden, DW; Cortina, GR; Thompson Jr, JE; Tompkins, RK; Chandler, C; Hines, OJ (2001). "Porcelain gallbladder is not associated with gallbladder carcinoma". The American Surgeon. 67 (1): 7–10. PMID 11206901.
- ^ Fiser, Steven (2013). The ABSITE Review (4th ed.). LWW. ISBN 978-1451186901.
- ^ a b Stephen, Antonia E.; Berger, David L. (2001). "Carcinoma in the porcelain gallbladder: A relationship revisited". Surgery. 129 (6): 699–703. doi:10.1067/msy.2001.113888. PMID 11391368.
- ^ Schnelldorfer, Thomas (June 2013). "Porcelain Gallbladder: A Benign Process or Concern for Malignancy?". Journal of Gastrointestinal Surgery. 17 (6): 1161–1168. doi:10.1007/s11605-013-2170-0. PMID 23423431.
- ^ Tomioka, T.; Tajima, Y.; Inoue, K.; Onizuka, S.; Ikematsu, Y.; Kanematsu, T. (March 1997). "Laparoscopic Cholecystectomy Is a Safe Procedure for the Treatment of Porcelain Gallbladder". Endoscopy. 29 (3): 225. doi:10.1055/s-2007-1004172. PMID 9201480.
- ^ Machado, Norman O. (November 2016). "Porcelain Gallbladder". Sultan Qaboos University Medical Journal. 16 (4): e416 – e421. doi:10.18295/squmj.2016.16.04.003. ISSN 2075-051X. PMC 5135451. PMID 28003886.
External links
[edit]- eMedicine.com – Porcelain Gallbladder by Ali Nawaz Khan and Margaret Aird