Kidogawa Hideo, Ootubo Kazuhiro, Noguchi Junya, Yamayoshi Takatomo, Okamoto Kohji
Department of Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, JPN.
Cureus. 2024 Oct 28;16(10):e72583. doi: 10.7759/cureus.72583. eCollection 2024 Oct.
Porcelain gallbladder is a rare condition characterized by an extensive calcification of the gallbladder wall. It is associated with an increased risk of gallbladder cancer and elevated levels of tumor marker CA19-9, which is typically seen in pancreatic and biliary cancers. We present a case of a 60-year-old woman who presented with upper abdominal pain and nausea. Imaging revealed both a porcelain gallbladder and common bile duct stones. Initially, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) for the removal of the common bile duct stones. Notably, following the removal of the stones, the patient's CA19-9 levels were significantly elevated, reaching 6076 U/mL. Subsequently, she underwent a laparoscopic cholecystectomy. Histopathological examination and immunostaining for CA19-9 were performed on the resected specimen. Histopathology revealed marked fibrosis, calcification, and xanthogranulomatous inflammation of the gallbladder wall without evidence of malignancy. Immunostaining showed strong CA19-9 positivity in the inflamed gallbladder mucosal epithelium. Postoperatively, the patient's CA19-9 levels returned to normal (17 U/mL). This case highlights that a benign porcelain gallbladder can present with abnormally high CA19-9 levels, potentially mimicking malignancy. Reports of CA19-9 elevation in porcelain gallbladder are limited, and in most cases, significant CA19-9 elevation has been associated with malignancy. This case also demonstrates that benign conditions such as biliary obstruction, chronic inflammation, and xanthogranulomatous cholecystitis can cause significant elevations in CA19-9 levels. Therefore, careful differentiation and comprehensive evaluation are crucial for accurate diagnosis and appropriate management in such cases.
瓷性胆囊是一种罕见的病症，其特征为胆囊壁广泛钙化。它与胆囊癌风险增加以及肿瘤标志物CA19-9水平升高相关，而CA19-9水平升高通常见于胰腺癌和胆管癌。我们报告一例60岁女性，她因上腹部疼痛和恶心就诊。影像学检查发现既有瓷性胆囊又有胆总管结石。起初，患者接受了内镜逆行胰胆管造影术（ERCP）以清除胆总管结石。值得注意的是，结石清除后，患者的CA19-9水平显著升高，达到6076 U/mL。随后，她接受了腹腔镜胆囊切除术。对切除标本进行了组织病理学检查和CA19-9免疫染色。组织病理学显示胆囊壁有明显纤维化、钙化和黄色肉芽肿性炎症，无恶性证据。免疫染色显示炎症胆囊黏膜上皮CA19-9呈强阳性。术后，患者的CA19-9水平恢复正常（17 U/mL）。该病例突出表明，良性瓷性胆囊可出现异常高的CA19-9水平，可能酷似恶性肿瘤。关于瓷性胆囊中CA19-9升高的报道有限，在大多数情况下，显著的CA19-9升高与恶性肿瘤相关。该病例还表明，诸如胆管梗阻、慢性炎症和黄色肉芽肿性胆囊炎等良性病症可导致CA19-9水平显著升高。因此，在此类病例中，仔细鉴别和综合评估对于准确诊断和恰当处理至关重要。
