Gómez-López Juan-Ramón, De Andrés-Asenjo Beatriz, Ortega-Loubon Christian
Department of General Surgery, University Clinic Hospital of Valladolid, Spain.
Department of Cardiac Surgery, University Clinic Hospital of Valladolid, Spain.
Ann Med Surg (Lond). 2014 Sep 16;3(4):119-22. doi: 10.1016/j.amsu.2014.09.002. eCollection 2014 Dec.
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.
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.
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.
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.
瓷性胆囊是一种非常罕见的病症，表现为胆囊壁钙化，12.5%至62%的患者会并发癌症，不过近期研究表明两者的关联较弱。
我们描述了一位80岁女性，她出现右上腹绞痛，疼痛放射至背部并伴有呕吐。体格检查发现黄疸，墨菲氏征阴性。肝胆超声显示为瓷性胆囊，她被转至外科团队安排进行胆囊切除术。一个月后，她出现全腹痛。影像学检查显示病变扩散至肝脏各叶、肝包膜和肝门，以及肺部。放弃了积极的手术治疗，她被转至肿瘤科。
瓷性胆囊的恶变风险存在争议。虽然目前的数据似乎表明其退变风险较低，但也有证据显示胆囊壁钙化的患者在统计学上确实有患胆囊癌的风险。腹腔镜胆囊切除术已成为一种安全有效的方法，推荐用于有胆囊症状的患者，无论这些症状与胆囊壁钙化有无直接关系。在本病例中，一个病理性胆囊很快发展成无法手术切除的肿瘤，预后不良。
本报告强调，若超声检查发现瓷性胆囊，应紧急进行CT扫描以评估是否存在潜在恶性病变，并且应尽快进行单纯胆囊切除术，而非列入常规择期手术名单，以尽可能预防可能的恶变。
