Association between Porcelain Gallbladder and Gallbladder Cancer

In studies reported 50 years ago, an association of porcelain gallbladder (PGB) with gallbladder cancer (GBC) was clearly established, with findings of incidence of cancer in PGB exceeding 60%. Since those early studies, diagnostic imaging has created greater sensitivity for detection of gallbladder calcification compared with plain film radiography. According to researchers, the more recent imaging technology has changed the definition of PGB, making the association of gallbladder calcification and cancer less clear. To update treatment recommendations for patients with PGB, the researchers recently conducted a retrospective analysis of their institutional experience with PGB as well as a systematic review of the available literature. They reported results of their study in Archives of Surgery [2011;146(10):1143-1147]. The study reviewed data from 2008 to 2009 from the Parkland Memorial Hospital, the University of Texas Southwestern Medical Center, and the Dallas Veterans Affairs Medical Center (all in Dallas, Texas). Using Current Procedural Terminology codes, the researchers identified patients undergoing cholecystectomy; they then reviewed histopathologic and diagnostic imaging for all patients undergoing cholecystectomy to establish a diagnosis of PGB. The systematic literature review was conducted using the MEDLINE database, searching for the following keywords: porcelain gallbladder, gallbladder calcification, calcified gallbladder, gallstones, and gallbladder carcinoma. The review also utilized Ovid syntax from 1949 to January 2010, the Cochrane Library, Google, and Google Scholar. In 1200 consecutive cholecystectomies performed at the 3 institutions during the study period, the researchers identified 13 patients with PGB. Most of the patients were women (n=8; 62%) who ranged in age from 32 to 69 years. Nine of the patients (69%) with a PGB had biliary symptoms; likewise, 9 (69%) had concomitant gallstones. In 3 of the patients, incidental diagnosis of PGB was made during radiographic examinations for urinary symptoms, back pain, or trauma. Nine (69%) of the 13 patients had complete transmural calcifications and 3 (23%) had mucosal calcifications. One patient had a diagnosis of PGB following review of sonogram and computed tomography results and underwent surgery. Postoperative histologic examination did not show wall calcifications; gallstones were found that may have given the appearance of wall calcification in imaging. None of the 13 patients had evidence of carcinoma. The literature review included 7 case series with sufficient information for analysis. The analysis included 7 reports representing 60,665 cholecystectomies. The overall incidence of PGB was 0.2% and the overall incidence of GBC was 0.8%; of these, 15% had an association between PGB and GBC. Over time, the incidence of GBC substantially decreased, becoming relatively rare in more recent series, the researchers found. In conclusion, the researchers stated, “Porcelain gallbladder is only weakly associated with GBC. Prophylactic cholecystectomy is not indicated for PGB alone and should be performed only in patients with conventional indications of cholecystectomy. A laparoscopic approach is appropriate for most patients with a PGB.”