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.

• 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

• 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)

• 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

• 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

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.