Does a Porcelain Gallbladder Equal Gallbladder Cancer?

Gallbladder cancer (GBC) incidence ranges from 12 – 62% when porcelain gallbladder (PGB) is seen. You ever wonder where these numbers come from? Well, these are the quoted numbers from two studies done in 1959 and 1966. These studies also indicated that if porcelain gallbladder was seen, that a prophylactic cholecystectomy should be performed. Is this the best evidence we have? Is there nothing more recent? Well, it turns out there is.

Study #1: [1]

What they did:

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

Results:

• 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

Study #2: [2]

What they did:

• Is there a correlation between Calcified gallbladder and GBC
• Retrospective review of 25,900 cholecystectomies at Massachusetts General Hospital

Results:

• 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

Study #3: [3]

What they did:

• Evaluate the risk of GBC in patients with PGB
• Retrospective analysis of 1200 cholecystectomies performed

Results:

• 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.

Take Home Points:

• 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

References:

1. Towfigh S et al. Porcelain Gallbladder is Not Associated with Gallbladder Carcinoma. Am Sure 2001. PMID: 11206901
2. Stephen AE et al. Carcinoma in the Porcelain Gallbladder: A Relationship Revisited. Surgery 2001. PMID: 11391368
3. Khan ZS et al. Reassessing the Need for Prophylactic Surgery in Patients with Porcelain Gallbladder: Case Series and Systematic Review of the Literature. Arch Surg 2011. PMID: 22006872

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