A porcelain gallbladder and a rapid tumor dissemination.

Abstract

INTRODUCTION:

Porcelain 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 REPORT:

We 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.

DISCUSSION:

There 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.

CONCLUSION:

This 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.

• Authors: Juan-Ramón Gómez-López, Beatriz De Andrés-Asenjo, Christian Ortega-Loubon
• Journal: Annals of medicine and surgery (2012) (Ann Med Surg (Lond)) Vol. 3 Issue 4 Pg. 119-22 (Dec 2014) ISSN: 2049-0801 [Print] England
• PMID: 25568797 (Publication Type: Case Reports)