Porcelain Gallbladder Nada Mustafa, MD and Shinil K Shah, DO*

Total Page：16

File Type：pdf, Size：1020Kb

Porcelain Gallbladder Nada Mustafa, MD and Shinil K Shah, DO*

ISSN: 2474-3682 Mustafa and Shinil . Clin Med Img Lib 2020, 6:157 DOI: 10.23937/2474-3682/1510157 Volume 6 | Issue 4 Clinical Medical Image Library Open Access IMAGE ARTICLE Clinical Image: Porcelain Gallbladder Nada Mustafa, MD and Shinil K Shah, DO* Check for Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, updates USA *Corresponding author: Shinil K Shah, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 4.156, Houston, TX 77030, USA, Tel: 713-500-7277, Fax: 713-383-3708 A 68-year-old man with a known history of cholelithi- tions) and an incidental 7 cm right renal mass. Patient asis presented with worsening epigastric and right up- underwent laparoscopic cholecystectomy in conjunc- per quadrant discomfort. He was afebrile, with mild tion with laparoscopic radical nephrectomy. Intraoper- leukocytosis (13.3 K/CMM) and normal liver function ative findings demonstrated porcelain gallbladder with tests. Ultrasound and CT (abdomen/pelvis) showed dense fibrotic adhesions. Pathology of the gallbladder cholelithiasis with gallbladder wall calcifications (Figure revealed cholelithiasis, chronic cholecystitis with focal 1A, Figure 1B and Figure 1C, arrow indicates calcifica- high-grade dysplasia and extensive calcified fibrosis of Figure 1: Ultrasound of the abdomen (A) demonstrates calcification in the wall of the gallbladder (arrow); which is also documented on CT scan (B & C, arrow). A calcified gallstone is also noted on ultrasound (A) and CT scan (C). Citation: Mustafa N, Shah SK (2020) Clinical Image: Porcelain Gallbladder. Clin Med Img Lib 6:157. doi. org/10.23937/2474-3682/1510157 Accepted: October 08, 2020; Published: October 10, 2020 Copyright: © 2020 Mustafa N, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Mustafa and Shah. Clin Med Img Lib 2020, 6:157 • Page 1 of 2 • DOI: 10.23937/2474-3682/1510157 ISSN: 2474-3682 gallbladder wall. Right kidney pathology showed 5.4 cm malignancy, the true incidence of malignancy in porce- clear cell renal cell carcinoma (WHO/ISUP Grade 2) with lain gallbladder is thought to be significantly lower than clear margins. The patient had an uneventful recovery. previously reported. Operative management is indicat- Although historically associated with increased risks of ed in symptomatic patients. Mustafa and Shah. Clin Med Img Lib 2020, 6:157 • Page 2 of 2 •.

Copy Link

Recommended publications

(NCCN Guidelines®) Hepatobiliary Cancers
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hepatobiliary Cancers Version 2.2015 NCCN.org Continue Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Panel Members Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion *Al B. Benson, III, MD/Chair † Renuka Iyer, MD Þ † Elin R. Sigurdson, MD, PhD ¶ Robert H. Lurie Comprehensive Cancer Roswell Park Cancer Institute Fox Chase Cancer Center Center of Northwestern University R. Kate Kelley, MD † ‡ Stacey Stein, MD, PhD *Michael I. D’Angelica, MD/Vice-Chair ¶ UCSF Helen Diller Family Yale Cancer Center/Smilow Cancer Hospital Memorial Sloan Kettering Cancer Center Comprehensive Cancer Center G. Gary Tian, MD, PhD † Thomas A. Abrams, MD † Mokenge P. Malafa, MD ¶ St. Jude Children’s Dana-Farber/Brigham and Women’s Moffitt Cancer Center Research Hospital/ Cancer Center The University of Tennessee James O. Park, MD ¶ Health Science Center Fred Hutchinson Cancer Research Center/ Steven R. Alberts, MD, MPH Seattle Cancer Care Alliance Mayo Clinic Cancer Center Jean-Nicolas Vauthey, MD ¶ Timothy Pawlik, MD, MPH, PhD ¶ The University of Texas Chandrakanth Are, MD ¶ The Sidney Kimmel Comprehensive MD Anderson Cancer Center Fred & Pamela Buffett Cancer Center at Cancer Center at Johns Hopkins The Nebraska Medical Center Alan P.
[Show full text]
Gallstone Disease: the Big Picture
GALLSTONE DISEASE: THE BIG PICTURE UNR ECHO PROJECT CLARK A. HARRISON, MD GASTROENTEROLOGY CONSULTANTS RENO, NEVADA DEFINITIONS CHOLELITHIASIS = stones or sludge in the gallbladder CHOLEDOCHOLITHIASIS = stones/sludge in the bile ducts CHOLECYSTITIS = inflamed gallbladder usually in the presence of stones or sludge CHOLANGITIS = stasis and infection in the bile ducts as a result of stones, benign stenosis, or malignancy GALLSTONE PANCREATITIS = acute pancreatitis related to choledocholithiasis with obstruction at the papilla GALLBLADDER AND BILIARY ANATOMY Gallbladder Cystic Duct Right and Left Intraheptics Common Hepatic Duct Common Bile Duct Ampulla of Vater Major Papilla BILIARY ANATOMY GALLSTONE EPIDEMIOLOGY • A common and costly disease • US estimates are 6.3 million men and 14.2 million women between ages of 20-74. • Prevalence among non-Hispanic white men and women is 8-16%. • Prevalence among Hispanic men and women is 9-27%. • Prevalence among African Americans is lower at 5-14%. • More common among Western Caucasians, Hispanics and Native Americans • Less common among Eastern Europeans, African Americans, and Asians GALLSTONE RISK FACTORS • Ethnicity • Female > Male • Pregnancy • Older age • Obesity • Rapid weight loss/bariatric surgery GALLSTONES: NATURAL HISTORY • 15%-20% will develop symptoms • *Once symptoms develop, there is an increased risk of complications. • Incidental or silent gallstones do not require treatment. • Special exceptions due to increased risk of gallbladder cancer: Large gallstone > 3cm, porcelain gallbladder, gallbladder polyp/adenoma 10mm or bigger, and anomalous pancreatic duct drainage GALLSTONES: CLINICAL SYMPTOMS • Biliary colic which is a misnomer and not true colic • Episodic steady epigastric or RUQ pain often radiating to the R scapular area • Peaks rapidly within 5-10 minutes and lasts 30 minutes to 6 hours or more • Frequently associated with N/V • Fatty meal is a common trigger, but symptoms may occur day or night without a meal.
[Show full text]
Porcelain Gallbladder – Case Report
© Borgis Porcelain gallbladder – case rePort *Konrad Wroński1, 2 1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland Head of Department: prof. Sergiusz Nawrocki, MD, PhD 2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland Head of Department: Andrzej Lachowski, MD summary Porcelain gallbladder is rare manifestation of chronic cholecystitis. calcification of the gallbladder wall is present between 0.06%-0.8% of cholecystectomy specimens. the pathogenesis is still unknown but it is believed that it caused by irritation the gallbladder by stones which lead to chronic inflammation associated with calcium deposit. calcification of the gallbladder wall is associated with risk of gallbladder cancer. the author of this article presented a case of a woman who was admitted to the hospital because of suspicion tumor of gallblad- der. the patient underwent open cholecystectomy during which porcelain gallbladder was removed. the author performed a literature review on porcelain gallbladder. Key words: porcelain gallbladder, calcification, treatment, surgery INTRODUCTION The patient was taken to the operating room for an Porcelain gallbladder is rare manifestation of chron- open cholecystectomy. During the surgical exploration ic cholecystitis. Calcification of the gallbladder wall is claimed calcification of the gallbladder wall. Porcelain present between 0,06-0,8% of cholecystectomy speci- gallbladder was removed (fig. 1-3). The material was mens (1, 2). The pathogenesis is still unknown but it is sent for routine histopathological examination. The time believed that it caused by irritation the gallbladder by of surgery was about 45 minutes. stones which lead to chronic inflammation associated Histopathology examination showed a porcelain gall- with calcium deposit.
[Show full text]
A Porcelain Gallbladder and a Rapid Tumor Dissemination
Annals of Medicine and Surgery 3 (2014) 119e122 Contents lists available at ScienceDirect Annals of Medicine and Surgery journal homepage: www.annalsjournal.com Case report A porcelain gallbladder and a rapid tumor dissemination * Juan-Ramon Gomez-L opez a, Beatriz De Andres-Asenjo a, Christian Ortega-Loubon b, a Department of General Surgery, University Clinic Hospital of Valladolid, Spain b Department of Cardiac Surgery, University Clinic Hospital of Valladolid, Spain highlights We report a patient with advanced gallbladder porcelain. Porcelain gallbladder is a very rare entity found in <1% of cholecystectomies. It consists of calcification of the gallbladder wall. The rapid progression of cancer in a porcelain gallbladder is more unusual. article info abstract Article history: Introduction: Porcelain gallbladder is a very rare entity that consists of a calcification of the gallbladder wall, Received 16 July 2014 and is associated with carcinoma in 12.5e62% of patients, although recent studies suggest weaker association. Received in revised form Case report: We describe an 80-year-old woman who presented with colicky abdominal pain in the right 2 September 2014 upper quadrant, radiating to the back and associated with vomiting. Physical examination revealed Accepted 4 September 2014 jaundice, murphy's sign was negative. Hepatic-biliary tract ultrasound revealed porcelain gallbladder, she was referred to the surgical team for Keywords: a scheduled cholecystectomy. A month later, she presented diffuse abdominal pain. Imaging studies Porcelain gallbladder Gallbladder calcification showed a disseminated process affecting liver's segments, capsule, and hilum; and lungs. An aggressive Gallbladder carcinoma surgical treatment was dismissed, and was referred to the oncology department.
[Show full text]
Biliary Pain Work-Up and Management in General Practice Michael Crawford
The right upper quadrant Biliary pain Work-up and management in general practice Michael Crawford Background Pain arising from the gallbladder and biliary tree is a Pain arising from the gallbladder and biliary tree is a common common presentation in general practice. Differentiating clinical presentation. Differentiation from other causes of biliary pain from other causes of abdominal pain can abdominal pain can sometimes be difficult. sometimes be difficult. There is substantial variability in the type, duration and associations of pain arising from the Objective gallbladder. Furthermore, there is overlap with a number This article discusses the work-up, management and after care of of other common abdominal conditions, such as peptic patients with biliary pain. ulcer disease, gastro-oesophageal reflux and irritable Discussion bowel syndrome. It is often not possible to be certain that The role for surgery for gallstones and gallbladder polyps is a particular symptom is related to gallbladder pathology described. Difficulties in the diagnosis and management before cholecystectomy. of gallbladder pain are discussed. Intra- and post-operative complications are described, along with their management. The Clinical presentations of pain issue of post-operative pain in particular is examined, focusing Gallstones on the timing of the pain and the relevant investigations. Gallstones are a common problem, with an estimated prevalence of Keywords 25–30% in Australians over the age of 50 years.1 Risk factors for the general surgery; gastrointestinal disease; gallbladder; biliary development of gallstones include: tract; pain • female gender • increasing age • family history • rapid changes in weight • ethnicity. Most people with gallstones do not experience pain, with only about 6% undergoing a cholecystectomy over a 30 year period in one observational study.2 Confirming that the gallbladder is the source of pain can be challenging.
[Show full text]
Gallbladder Disease and Normal Variants { Common Clinical Findings
Gallbladder Disease and Normal Variants { Common Clinical Findings Eva Tutone BS,RDMS,RVT Duke University Hospital Gallbladder Anatomy Right lobe of Liver Three sections : Fundus, Body, Neck Cystic duct connects gallbladder to common bile duct Hartmann’s Pouch…common place for Gallstones! Gallbladder Anatomy Gallbladder Function Bile storage Concentration of bile Release into small intestine Fat emulsification Anatomical Variants Abnormal Positioning Agenesis Duplication Phrygian Cap Micro gallbladder Multiseptate Abnormal Position Very rare to be in left lobe. About 1 case per year in population imaged Detached gallbladder or Ectopic positioning Suprahepatic GB in right lobe of liver Agenesis of Gallbladder Very rare condition Often asymptomatic if only anomaly Sometimes seen with other internal malformations such as : genitourinary renal reproductive Agenesis Gallbladder duplication No increased chance of malignancies or stones Can be bilobed, incomplete gallbladder with common cystic duct Complete duplication with separate cystic ducts that lead to hepatic duct Complete duplication with common cystic duct entering to hepatic duct Gallbladder duplication Gallbladder Duplication Phrygian Cap Most common variant Fold in the fundus No pathological significance and asymptomatic Phrygian Cap Micro Gallbladder Usually less than 2-3 cm long and .5-1.5cm wide Often thick walled Due to Cystic Fibrosis Micro Gallbladder due to Cystic Fibrosis Multiseptate Common finding 3-10 communicating compartments of columnar epithelium Can cause immobility
[Show full text]
Ministry of Healthcare of Ukraine Ukrainian Medical Stomatological Academy
Ministry of Healthcare of Ukraine Ukrainian Medical Stomatological Academy Approved at the meeting of Internal Medicine №1 Department “____”__________2019 yr. Protocol № ____ from ___________ The Head of the Department Associate Professor Maslova H.S. ______________ Methodical guidelines for students’ self-studying to prepare for practical (seminar) classes and on the lessons Academic discipline Internal medicine Module № 1 Topic of the lesson Chronic cholecystitis and functional biliary disorders. Cholelithiasis. Course IV Faculty of foreign students training Poltava-2019 1. Relevance of the topic: Chronic cholecystitis is a prolonged, subacute condition caused by the mechanical or functional dysfunction of the emptying of the gallbladder. It presents with chronic symptomatology that can be accompanied by acute exacerbations of more pronounced symptoms (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). There are classic signs and symptoms associated with this disease as well as prevalences in certain patient populations. The two forms of chronic cholecystitis are with cholelithiasis (with gallstones), and acalculous (without gallstones). Functional biliary disorders are controversial topics. They have gone by a variety of names, including acalculous biliary pain, biliary dyskinesia, dysmotility. 2. Certain aims: - To be able to assess the typical clinical picture of chronic calculous and acalculous cholecystitis and functional biliary disorders, to determine
[Show full text]
Risk Factors for the Onset of Gallbladder Cancer: a Review
International Surgery Journal Tan Z et al. Int Surg J. 2021 Jun;8(6):1951-1958 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: https://dx.doi.org/10.18203/2349-2902.isj20212301 Review Article Risk factors for the onset of gallbladder cancer: a review Zhiyong Tan1, Zhuofan Deng2, Jianping Gong2* 1Department of of Hepatobiliary Surgery, Yunyang County People's Hospital of Chongqing, Chongqing, China 2Department of Hepatobiliary Surgery, Second affiliated Hospital of Chongqing Medical University, Chongqing, China Received: 03 April2021 Revised: 26 April 2021 Accepted: 30 April 2021 *Correspondence: Dr. Jianping Gong, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Gallbladder cancer (GBC) is the most common malignancy of the biliary system in clinic, which has the characteristics of insidious onset and high degree of malignancy. Most patients have progressed to an advanced stage when they are diagnosed. Early identification of risk factors of the onset of gallbladder cancer and active intervention are the key to improve the rate of early diagnosis and prognosis of gallbladder cancer. At present, the risk factors related to the onset of gallbladder cancer include gallstone, gallbladder polyps, primary sclerosing cholangitis, etc. In this review, we discuss the relevant latest research on the risk factors of the onset of gallbladder cancer in order to provide clinical evidence for the prevention and early diagnosis of gallbladder cancer.
[Show full text]
Interventional Radiology's Role in the Diagnosis and Management Of
Review Article Page 1 of 13 Interventional radiology’s role in the diagnosis and management of patients with gallbladder carcinoma Gabriel C. Fine1, Tyler A. Smith1, Seth I. Stein2, David C. Madoff2 1Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 2Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine, New York, NY, USA Contributions: (I) Conception and design: GC Fine, DC Madoff; (II) Administrative support: GC Fine, DC Madoff; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: David C. Madoff, MD. Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE-2, New Haven, CT 06520, USA. Email: [email protected]. Abstract: Gallbladder carcinoma is a rare, aggressive biliary tract malignancy, with a 5-year survival of less than 5%. It is the 6th most common gastrointestinal malignancy in the United States and more commonly found in women. While some risk factors include gallstones, porcelain gallbladder, and smoking, gallbladder carcinoma is often found incidentally following cholecystectomy or percutaneous image guided biopsy. Patients frequently present in a late disease state when they are no longer surgical candidates and minimally invasive image guided-interventions therefore play a critical role in the management and treatment of these patients. This review will discuss some of the key procedures and roles interventional radiologists play in the diagnosis and management of patients suffering from gallbladder carcinoma including tissue sampling, placement of intra-arterial infusion pumps, preoperative portal vein embolization (PVE), biliary drainage, management of post-operative complications such as bile leaks or biliary obstruction, and management of chronic pain.
[Show full text]
Gallbladder Masses: Multimodality Approach to Differential Diagnosis
Gallbladder Masses, McKnight et al. Gallbladder Masses: Multimodality Approach to Differential Diagnosis Timothy McKnight, D.O.,1 and Ankit Patel, D.O.2 1Dartmouth Hitchcock Medical Center, Department of Radiology, Lebanon, NH 2University of California Irvine Medical Center, Department of Radiology, Irvine, CA Introduction Gallbladder masses are commonly encountered on diagnostic imaging examinations. Distinguishing between benign and malignant conditions is critical, in terms of clinical significance, management, and follow- up. It is important to be familiar with the differential diagnoses of gallbladder masses, recognize imaging features that are diagnostic for each condition, and understand the utility and limitations of each of the cross-sectional imaging modalities currently available. Gallbladder pathology is a frequent source of patient complaint, to include acute or chronic right upper quadrant pain, jaundice, or dyspepsia. As such, the gallbladder is a routinely imaged structure either directly to exclude or characterize gallbladder pathology or in general abdominal imaging for nonspecific complaints or imaging related to adjacent structures. Gallbladder masses as part of the spectrum of gallbladder pathology are commonly encountered at imaging. It is important for the diagnostic imager to be familiar with the broad differential of gallbladder masses. While most gallbladder masses are benign and do not present a diagnostic dilemma, they may present with unusual or nonspecific imaging appearances, or on a modality that is not
[Show full text]
Porcelain Gallbladder: Often an Overlooked Entity
THIEME Case Report e145 Porcelain Gallbladder: Often an Overlooked Entity Sohail Iqbal, MBBS, MSc1 Sarfraz Ahmad, FRCR2 Usman Saeed, FRCR2 Mohammed Al-dabbagh, FRCR3 1 Department of Cardiac Imaging, North West Heart Centre, Address for correspondence Sohail Iqbal, MBBS, MSc, Department of Manchester, United Kingdom Cardiac Imaging, North West Heart Centre, Manchester, M23 9LT, 2 Radiology Department, Royal Blackburn Hospital, ELHT, United Kingdom (e-mail: [email protected]). Blackburn, United Kingdom 3 Radiology Department, Colchester General Hospital, CHUFT, Colchester, United Kingdom Surg J 2017;3:e145–e147. Abstract Background Porcelain gallbladder (GB) is a rare but potentially premalignant condi- tion with minimal symptoms. Accident and Emergency (A&E) departments often tend to investigate abdominal pain through plain radiographs, which are occasionally reported by radiologists, thereby leaving behind few uncommon conditions, such as porcelain gallbladder unreported. Objectives We present three cases of porcelain GB in which initial diagnosis was not considered due to the presence of various other calcifications in the upper abdomen. Methods In A&E, plain abdominal X-rays were routinely performed in all three patients to investigate nonspecific postprandial abdominal pain. Although GB calcification was easy to diagnose on plain films, it was initially overlooked to be a cause of the symptoms and later was diagnosed on abdominal CT scans, performed for further evaluation. Results Abdominal X-rays revealed thin curvilinear calcification in the GB wall, partially Keywords calcified neck and body, and gall stones. CTscan confirmed porcelain GB in all three patients. ► porcelain gallbladder Conclusion Gallbladder mural calcification is a rare cause of nonspecificabdominal ► cancer pain, which is often overlooked on plain abdominal X-rays causing missed diagnosis.
[Show full text]
6) Chronic Cholesystitis. Gallstones
Міністерство охорони здоров’я України Харківський національний медичний університет Кафедра Внутрішньої медицини №3 Факультет VI по підготовці іноземних студентів ЗАТВЕРДЖЕНО на засіданні кафедри внутрішньої медицини №3 29 серпня 2016 р. протокол № 13 Зав. кафедри _______д.мед.н., професор Л.В. Журавльова МЕТОДИЧНІ ВКАЗІВКИ для студентів з дисципліни «Внутрішня медицина (в тому числі з ендокринологією) студенти 4 курсу І, ІІ, ІІІ медичних факультетів, V та VI факультетів по підготовці іноземних студентів Жовчнокам’яна хвороба, хронічний холецистит та функціональні біліарні порушення Харків 2016 KHARKOV NATIONAL MEDICAL UNIVERSITY DEPARTMENT OF INTERNAL MEDICINE N3 METHODOLOGICAL RECOMMENDATIONS FOR STUDENTS "Gallstone disease, chronic cholecystitis and functional biliary disorders" Kharkiv 2016 Practical class: “Gallstone disease (GD), chronic cholecystitis (CC) and functional biliary disorders”, 4 hours The incidence of biliary tract diseases, including GD and chronic cholecystitis is high around the world. GD has not only medical, but also socio-economic importance. The number of patients with biliary tract diseases is almost twice higher than the number of patients with peptic ulcer. The disease occurs 2-3 times more frequently in women than in men. The incidence of gallstone formation in children is less than 5%, whereas in elderlies of 60-70 years old it is equal to 30-40%. 80-90% of patients with GD reside in Europe and North America and typically have cholesterol stones, while the population of Asia and Africa tend to have pigment stones. Learning Objectives: To teach students to recognize the major symptoms and syndromes of GD; Physical methods of GD investigation; Lab and instrumental tests for diagnosis of DG; To teach students to interpret the results of additional methods of investigation; To teach students to recognize and diagnose GD complications; To teach students to prescribe treatment for GD.
[Show full text]