Porcelain Gallbladder

The term ‘porzellangallenblase’ (porcelain gallbladder) was proposed by Heinrich Florcken ¹ (Frankfurt), in 1929, to denote the changes seen in an inflammatory condition that caused calcification of the gallbladder wall. It was presumably meant to emphasize ‘the brittle consistency and bluish discoloration of the wall’ ² . Although Florcken considered it to be the result of a previous inflammatory process and of no consequence, other cases were soon reported that disputed its supposed innocuous nature ³ . These gallbladders may function poorly and often contain gallstones. Gallbladder carcinoma, a relatively uncommon gastrointestinal tract malignancy, has an increased incidence in cases of porcelain gallbladder. The pattern of calcification in the gallbladder wall is important when one is considering the possibility of carcinoma (Figure 1). ‘Incomplete calcification of the wall is much more likely to be associated with [gallbladder carcinoma] than the complete type.’ ⁴ This is likely to be due to the fact that with complete calcification the mucosal epithelium is totally replaced by dense connective tissue that is not prone to undergo a cancerous change. Ultrasound and computerized tomography can also be used to detect and evaluate porcelain gallbladders. A giant gallstone is one plain film mimic that also has been reported to have an association with the development of a gallbladder carcinoma. Figure 1 Abdominal radiograph showing calcified gallbladder. Case courtesy of Dr D. Fleming, Bethesda Naval Hospital https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig66_1_B.jpg"/>