Porcelain Gallbladder

Definition

A porcelain gallbladder, is finding of marked gallbladder wall thickening with calcifications. It is an ominous sign that is believed to be associated with gallbladder carcinoma. It is called porcelain, owing to the extensive calcifications, bluish discoloration, and brittle consistency of the wall.

The only known causes is chronic inflammation of the gallbladder in chronic cholecystitis, though it is uncommon even in this setting. Recent studies have suggested that although an association with this condition and carcinoma exists, it may only be a weak association with between 1 in 20 to 1 in 100 or less having cancer.

Imaging is typically accomplished with x-ray and CT radiography, although ultrasonography, or MR may also be used.

Porcelain Gallbladder – Variant of Chronic Inflammation

This is a specimen xray of a resected gallbladder. The walls were thin, fibrotic and heavily calcified, accounting for the radiodense (white) areas on the radiograph. This variant of chronic cholecystitis is a risk factor for development of carcinoma.

11939.8s gallbladder porcelain gallbladder X-ray Courtesy Barbara Banner MD

Porcelain Gallbladder – Variant of Chronic Inflammation

This photomicrograph at low power shows most of the full thickness of the wall of a gallbladder. The lumen is the clear area at one side of the picture. The pale homogeneous area down the middle is fibrous replacement of the wall. The little nubbin of tissue and cholesterol clefts along the lumen represents what is left of the mucosa. The darker, zig-zag structure at the side opposite the lumen represents where the gallbladder wall is calcified. This calcification and fibrosis of the entire gallbladder wall is the diagnostic feature of porcelain gallbladder.

11940.8s gallbladder porcelain gallbladder histopathology Courtesy Barbara Banner MD

Porcelain Gallbladder with Calcified Stone

In this CTscan calcification of the wall of the gallbladder (green) is associated with a large calcified stone (yellow) that appears to be impacted in the neck. Cholesterol stones are usually isodense with the bile but in this case it has calcified. The large size of the stone suggests its cholesterol nature in this case.

76225c01 gallbladder wall calcification calcified porcelain gallbladder premalignant CTscan Courtesy Ashley Davidoff MD

Porcelain Gallbladder

47683c01 gallbladder fx calcification in wall calcified wall dx porcelain gallbladder CTscan Davidoff MD

Reference

Liang et al Porcelain Gallbladder