Carcinoma in the porcelain gallbladder: A relationship revisited

doi:10.1067/msy.2001.113888

Surgery

Volume 129, Issue 6, June 2001, Pages 699-703

https://doi.org/10.1067/msy.2001.113888 Get rights and content

Abstract

Background. Gallbladder cancer is the most common biliary tract malignancy. Calcification of the gallbladder wall is reported to be associated with gallbladder cancer. In the literature, the incidence is quoted to be between 12% and 61%. This study aims to clarify the risk of cancer in a calcified gallbladder. Methods. The charts and pathology reports at the Massachusetts General Hospital were reviewed, and patients with either gallbladder cancer or a calcified gallbladder were included in the study. The Fisher exact test was used to test for the association between cancer and gallbladder wall calcifications. Results. From 1962 to 1999, there were approximately 25,900 gallbladder specimens analyzed at the Massachusetts General Hospital. There were 150 patients with gallbladder cancer and 44 patients with calcified gallbladders. Two types of calcified gallbladders were noted: those with complete intramural calcification (n = 17) and those with selective mucosal calcification (n = 27). The incidence of cancer arising in a gallbladder with selective mucosal wall calcification was approximately 7%. There was a significant association between gallbladder cancer and selective mucosal calcification with an odds ratio of 13.89 (P =.01). There were no patients with diffuse intramural calcification and cancer. Conclusions. A calcified gallbladder is associated with an increased risk of gallbladder cancer, but at a much lower rate than previously estimated. The incidence of cancer depends on the pattern of calcification; selective mucosal calcification poses a significant risk of cancer whereas diffuse intramural calcification does not. (Surgery 2001;129:699-703.)

Section snippets

Methods

The charts and pathology reports from Massachusetts General Hospital from 1962 to 1999 were reviewed and selected for patients who had the diagnosis of either gallbladder cancer or a calcified gallbladder wall. Included in the study were patients who underwent a complete cholecystectomy with pathologic examination of the specimen. Patients with a diagnosis of gallbladder cancer determined solely on radiographic studies or surgical exploration and biopsy specimen examination were excluded from

Results

From 1962 to 1999, there were approximately 25,900 gallbladder specimens analyzed in the pathology department at Massachusetts General Hospital. There were 150 patients with gallbladder cancer who underwent cholecystectomy as part of their treatment. There were an additional 26 patients with gallbladder cancer diagnosed by evaluation of a biopsy specimen from a gallbladder mass noted at surgical exploration. These latter patients were excluded from the final analysis because the entire

Discussion

Gallbladder cancer is a notoriously aggressive disease that is diagnosed late and carries a poor prognosis from the time of diagnosis. The average incidence of gallbladder cancer is estimated to be between 0.55% and 1.91%.⁴ Several potential risk factors have been identified and evaluated (Table II).

. Proposed risk factors for gallbladder cancer

Gallstones

Large gallstones > 3.0 cm

Cholecystoenteric fistula

Anomalous pancreaticobiliary junction

Gallbladder adenoma or polyps

Calcified or porcelain

Acknowledgements

We thank Dr Mary Jane O'Neill for providing ultrasound photographs and for assistance in interpretation of the radiologic studies, Dr David Schoenfeld for his help with the statistical analysis, Dr David macLaughlin for critically reviewing the manuscript, and Barrett Goodspeed for providing the pathology reports.

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There are more references available in the full text version of this article.

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^*: Reprint requests: David L. Berger, MD, Department of Surgery, ACC 465, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114.

^**: Surgery 2001;129:699-703

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Original CommunicationsCarcinoma in the porcelain gallbladder: A relationship revisited*,**

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Gastroenterology

Am J Surg

Primary carcinoma of the gallbladder

Surg Gynecol Obstet

Gallbladder cancer

Gallbladder carcinoma

Ann Oncol

Carcinoma of the gallbladder and extrahepatic bile ducts

Semin Oncol

Gallstone size and the risk of gallbladder cancer

JAMA

Original Communications
Carcinoma in the porcelain gallbladder: A relationship revisited*,**