Pielaciński Konrad, Bosak Agata, Pielaciński Jan, Paluszkiewicz Piotr
Department of General, Oncologic and Metabolic Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Pol Merkur Lekarski. 2022 Dec 22;50(300):384-387.
Gallbladder calcification known as porcelain gallbladder (PGB) is most often asymptomatic disease developing in consequence of chronic inflammatory process in the course of other gallbladder diseases (gallstone disease). In the past PGB was reported to be associated with carcinoma of gallbladder, with the incidence of 30%, nowadays recent studies suggesting a rate of 6%. Patients with PGB due to malignancy risk undergo , prophylactic cholecystectomy although as recent studies show part of them could avoid it.
Presentation of a case of a patient with calcification of the gallbladder wall and suspicion of gallbladder cancer and a review of the literature.
A 66-year-old woman was admitted with a diagnosis of PGB and concomitant diseases with a high risk of adverse events. PGB was detected through incidentally 4 months earlier, during the diagnosis of abdominal pain caused by the sigmoid volvulus. Computed tomography revealed enlarged (125mm x 57mm) PGB and abnormal tissue components into the fundus of gallbladder- suspected malignancy. No detected lymphadenopathy and growing cancer into liver, or invading, nearby organs. The patient underwent open extended (radical) cholecystectomy. Gallbladder was excised with fused part of greater omentum and adjacent, wedge-shaped part of liver parenchyma. Lymphadenectomy of the hepatoduodenal ligament and resection of cystic duct stump was also performed. There was no postoperative complication, patient was discharged six days after the surgery. No gallbladder cancer was found in the histopathological examination. There were fund cholecystolithiasis, chronic cholecystitis with hyalinization and calcification of the wall, chronic limphadenitis and glandular epithelium in the stump of the cystic duct.
Patient with PGB and suspicion of gallbladder cancer was treated with open extended cholecystectomy. Histopathological examination has not revealed gallbladder cancer.
Open extended cholecystectomy has proven to be an effective and safe treatment for a patient with a porcelain gallbladder at high risk of cancer.
胆囊钙化即瓷性胆囊（PGB）通常是在其他胆囊疾病（胆结石病）病程中的慢性炎症过程所引发的无症状疾病。过去据报道瓷性胆囊与胆囊癌相关，发生率为30%，如今近期研究表明该发生率为6%。因存在恶性风险，患有瓷性胆囊的患者会接受预防性胆囊切除术，不过正如近期研究所显示的，部分患者可以避免该手术。
介绍一例胆囊壁钙化且怀疑患有胆囊癌的患者病例，并对相关文献进行综述。
一名66岁女性因诊断为瓷性胆囊及伴有不良事件高风险的合并症入院。瓷性胆囊是在4个月前因乙状结肠扭转引起腹痛进行诊断时偶然发现的。计算机断层扫描显示瓷性胆囊增大（125毫米×57毫米），胆囊底部有异常组织成分——怀疑为恶性。未检测到淋巴结肿大，也未发现癌症向肝脏生长或侵犯附近器官。患者接受了开放性扩大（根治性）胆囊切除术。切除胆囊时连带切除了大网膜融合部分以及肝实质相邻的楔形部分。还进行了肝十二指肠韧带淋巴结清扫和胆囊管残端切除。术后无并发症，患者术后6天出院。组织病理学检查未发现胆囊癌。有胆囊底部结石、伴有胆囊壁玻璃样变和钙化的慢性胆囊炎、慢性淋巴结炎以及胆囊管残端的腺上皮。
患有瓷性胆囊且怀疑患有胆囊癌的患者接受了开放性扩大胆囊切除术。组织病理学检查未发现胆囊癌。
对于具有高癌症风险的瓷性胆囊患者，开放性扩大胆囊切除术已被证明是一种有效且安全的治疗方法。
