Re: porcelain gallbladder

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Agnes


Porcelain Gallbladder

Extensive calcium encrustation of the gallbladder wall variably has been termed calcified gallbladder, calcifying cholecystitis, or cholecystopathia chronica calcarea. The term Porcelain Gallbladder has been used to emphasize the blue discoloration and brittle consistency of the gallbladder wall at surgery. Some authorities amalgamate the terms and call all calcified gallbladders Porcelain Gallbladder s. The true incidence of porcelain gallbladder is unknown, but it is reported to be 0.6-0.8%, with a male-to-female ratio of 1:5. Most porcelain gallbladders (90%) are associated with gallstones.

Patients are usually asymptomatic, and porcelain gallbladder is found incidentally on plain abdominal radiographs, sonograms, or CT images.



Pathophysiology: Histologically, flakes of dystrophic calcium exist within the chronically inflamed gallbladder wall. The muscular wall of the gallbladder undergoes fibrotic changes. Microliths are diffusely scattered throughout the mucosa, submucosa, and glandular spaces and in the Rokitansky-Aschoff sinuses. Calcification occurs in 2 forms: (1) a broad continuous band of calcification in the muscularis and (2) multiple punctate calcifications in the mucosa and glandular spaces of the mucosa. Gallstones are present in 90% of patients, hydrops obstructs the cystic duct. Most authorities consider gallbladder wall calcification to be secondary to a low-grade inflammation, but intramural hemorrhage and an imbalance in calcium metabolism also are implicated.

Frequency:

In the US: The overall incidence in the United States appears to be identical to the international incidence.
Internationally: Because most cases of gallbladder calcifications are not reported, determining the exact incidence is difficult. However, studies of cholecystectomy specimens reveal a 0.6-0.8% occurrence rate for extensive mural calcification.