Does a Porcelain Gallbladder Equal Gallbladder Cancer?

Polk HC Jr (1966) and Cornell CM et al (1959) reported the incidence of gallbladder cancer (GBC) to range from 12–62% when porcelain gallbladder (PGB) is seen. The standard for treatment of porcelain gallbladder is prophylactic cholecystectomy. In the past decade, three large studies by Towfigh S et al (2001), Stephen AE et al (2001), and Khan ZS et al (2011) evaluated this teaching.


What they did:
  • Evaluate characteristics of patients with PGB and risk for GBC
  • Retrospective review of 10,741 cholecystectomies


  • 15/10,741 (0.14%) had PGB
  • 88/10,741 (0.82%) had GBC
  • No carcinoma identified among patients with PGB
  • No carcinoma identified among patients with calcified gallbladder


Conclusion: There is no association of PGB and GBC.


    What they did:
    • Is there a correlation between calcified gallbladder and GBC
    • Retrospective review of 25,900 cholecystectomies at Massachusetts General Hospital


    • 150/25,900 (0.58%) had GBC
    • 44/25,900 (0.17%) had Calcified Gallbladder
    • 17/44 (38.6%) had complete intramural calcification of GB
    • No GBC seen in complete intramural calcification of GB
    • 27/44 (61.4%) had selective mucosal wall calcification of GB
    • Incidence of GBC in selective mucosal wall calcification was 7% (OR 13.89)


    Conclusion: The incidence of GBC depends on the pattern of calcification; selective mucosal calcification poses a significant risk of cancer whereas diffuse intramural calcification does not.


    What they did:
    • Evaluate the risk of GBC in patients with PGB
    • Retrospective analysis of 1200 cholecystectomies performed


    • 13/1200 (1.1%) patients had a PGB
    • None of the patients with a PGB had evidence of GBC


    Conclusion: PGB is not associated with GBC.


    In my opinion, how will this affect your practice?
    • Complete intramural calcification of the gallbladder has no association with gallbladder cancer
    • Selective mucosal wall calcification of the gallbladder has a 7% incidence of gallbladder cancer
    • Not all porcelain gallbladders require prophylactic cholecystectomy



    1. Khan ZS et al. Reassessing the Need for Prophylactic Surgery in Patients With Porcelain Gallbladder. Arch Surg 2011; 146 (10): 1143 – 1147. PMID: 22006872

    2. Stephen AE et al. Carcinoma in the Porcelain Gallbladder: A Relationship Revisited. Surgery 2001; 129: 699 – 703. PMID: 11391368

    3. Towfigh S et al. Porcelain Gallbladder is Not Associated with Gallbladder Carcinoma. Am Surg 2001 Jan; 67 (1): 7 – 10. PMID: 11206901


    Dr. Salim R. Rezaie is a physician at the University of Texas Health Science Center at San Antonio. He is double board-certified in Emergency Medicine and Internal Medicine.

    About Salim Rezaie

    Dr. Rezaie completed his medical school training at Texas A&M Health Science Center, and followed that up with a combined Emergency Medicine/Internal Medicine residency at East Carolina University in Greenville, NC. Currently, he is an attending on the faculty of UTHSCSA in San Antonio, TX, where he focuses on medical education, social media as a tool for education (FOAMed), and building the bridges between internal medicine, critical care, and emergency medicine. Feel free to contact him on Twitter (@srrezaie) (@UTHSCSAPearls) about anything EM/IM! Salim Rezaie

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