Porcelain Gallbladder: a Unique Portrait
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IMAGES IN SURGERY
Porcelain Gallbladder: a Unique Portrait Sandip Kumar Halder 1
&
Aheli Ghosh Dastidar 2
&
Piyas Sengupta 1
&
Subhabrata Das 1
Received: 23 September 2020 / Accepted: 14 October 2020 # Association of Surgeons of India 2020
Abstract A 70-year-old lady presented with a 5-month history of dull, right upper quadrant abdominal pain, associated with nausea, vomiting and anorexia. Clinical examination revealed hepatomegaly and a hard palpable lump in continuity with the liver. Abdominal CT scan revealed striking images of calcification of the gallbladder wall, along with a hyperdense stone with central lucency, in its lumen. Hepatic lesions suggestive of liver infiltration were also noted, probably from gall bladder malignancy. We present this CT image, because of its striking depiction of porcelain gallbladder and as a reminder of its association with malignancy. Keywords Porcelain gallbladder . Gallstone . Gallbladder malignancy
A 70-year-old lady presented right upper quadrant abdominal pain, anorexia and vomiting for 5 months. Abdominal examination revealed hepatomegaly, and a hard lump in continuity, probably of gallbladder origin. Routine tests revealed anaemia and poor glycaemic control. CT scan of the abdomen revealed striking images of calcification of the entire gallbladder wall, along with a hyperdense stone with a lucent core (Fig. 1). It also showed hepatic lesions suggestive of liver infiltration, probably from gall bladder malignancy (Fig. 2). However, cyto-/histopathological confirmation of malignancy could not be achieved because the patient’s family opted against further treatment. The pathogenesis of gallstone formation is generally believed to involve biliary stasis and supersaturation of bile, to
crystal formation. Progression of the same pathology is hypothesised to lead to the development of porcelain gall bladder; this is described as a diffuse calcification of the gallbladder wall, usually intramural, but sometimes mucosal [1, 2]. The association of porcelain gallbladder with epithelial dysplasia, metaplasia, intestinal and gastric metaplasia, along with the variable risk of malignancy, necessitates caution in its management. The incidence of gallbladder carcinoma in patients with porcelain gallbladder was considered to be as high as 60%, in earlier reports. [3] Recent literature however, suggest a much lower incidence, thereby questioning the conventional indication of prophylactic cholecystectomy in these
* Aheli Ghosh Dastidar [email protected] Sandip Kumar Halder [email protected] Piyas Sengupta [email protected] Subhabrata Das [email protected] 1
Department of Surgery, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
2
R G Kar Medical College and Hospital, Kolkata, West Bengal, India
Fig. 1 CT scan image showing porcelain gallbladder with a stone in the lumen with a central lucency
Indian J Surg
[1]. The striking feature of this CT image is the coexistence of a large radio-opaque gallstone alongside the intramural gallbladder
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