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LETTER TO EDITOR
Year : 2011  |  Volume : 48  |  Issue : 1  |  Page : 132-134
 

Cancer in porcelain gallbladder - Rare imaging trait


1 Department of Radiology and Imaging, PSG IMSR, Coimbatore-641004, India
2 Military Hospital, Barelly, U.P., India
3 Department of Radiology and Imaging, AFMC, Pune - 411 040, India

Date of Web Publication10-Feb-2011

Correspondence Address:
K K Sen
Department of Radiology and Imaging, PSG IMSR, Coimbatore-641004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.76646

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How to cite this article:
Sen K K, Upadhyaya A, Pimpalwar Y, D'souza J. Cancer in porcelain gallbladder - Rare imaging trait. Indian J Cancer 2011;48:132-4

How to cite this URL:
Sen K K, Upadhyaya A, Pimpalwar Y, D'souza J. Cancer in porcelain gallbladder - Rare imaging trait. Indian J Cancer [serial online] 2011 [cited 2019 Aug 24];48:132-4. Available from: http://www.indianjcancer.com/text.asp?2011/48/1/132/76646


Sir,

Ultrasonography (US) in a 70-year-old lady, with features of resistant obstructive jaundice and postintervention status, revealed intrahepatic biliary radicular dilatation, a stent in the common bile duct, and calculus in the gallbladder [Figure 1]. The gallbladder wall, though appeared hyperechoic, was devoid of any posterior acoustic shadowing. Two echo-poor oblong hepatic lesions in the left lobe were thought to be part of the dilated biliary channels. Abdominal lymph adenopathy (periportal, celiac, and peripancreatic groups) was also detected.
Figure 1: Ultrasonography demonstrates heterogeneously echogenic gallbladder wall without any distal acoustic shadowing, a calculus at the neck of the gall bladder, and a stent in the common bile duct

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Subsequent computerized tomography (CT) demonstrated a gallbladder with mural plaque, discretely calcified irregularly thickened wall [1] and a dense stone of higher X-ray attenuation value of Hounsfield Unit (HU) 1108-1251 within [Figure 2] and [Figure 3]. A bowel loop was adherent to the wall of the gallbladder. Contrast-enhanced CT (CECT) of the abdomen revealed features of hepatic infiltration with intrahepatic biliary radicular dilatation [2] likely due to metastatic deposits. However, CECT of thorax did not demonstrate any evidence of metastasis. Cytological confirmation was obtained following ultrasound-guided fine needle aspiration of tissue from the abdominal lymph nodal mass, which on histopathology revealed adenocarcinoma. Palliative surgery and cytology confirmed the preoperative imaging and FNAC results.
Figure 2: CT abdomen showing calcified mural plaque in the gallbladder

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Figure 3: NC CT demonstrates a dense stone within the gallbladder, enlarged coeliac group of lymph nodes, and stent in CBD.

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  • Cross-sectional imaging, particularly US and CT, was of extreme importance for an immediate preoperative diagnosis and staging with high level of accuracy. It will be worthwhile to undertake CECT studies of the thorax and abdomen as a protocol in such cases. Its main advantage lies in showing tumor infiltration into the adjacent viscera [Figure 4] or vessels, lymph node, and distant metastasis. When gallbladder carcinoma is suggested by US findings, positron emission tomography can be considered complementary to establish the benign/malignant nature of the lesion and to obtain a primary staging study [3] with an improved specificity. Review of literature indicated that US features of a porcelain gallbladder can have four distinct patternsa hyperechoic semilunar structure with posterior acoustic shadowing that simulates a stone-filled gallbladder devoid of bile
  • A biconvex curvilinear echogenic structure with variable acoustic shadowing
  • An irregular clump of echoes with posterior acoustic shadowing
  • An echogenic gallbladder wall without acoustic shadowing
Figure 4: Well-defined round peripherally enhancing lesions seen in left lobe of liver, pooled oral contrast within intrahepatic biliary radicles visualized on CT

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Diagnosis of porcelain gallbladder with unusual imaging manifestation and artifacts in this patient was possible, since the variant features on ultrasound were taken into account and correctly interpreted by the vigilant sonologist.

 
  References Top

1.Haaga JR , Lanzieri CF. CT and MR Imaging of the Whole Body. Vol. 2, 4th ed. 2003. p. 1351-8.  Back to cited text no. 1
    
2.Rawat NS, Negi A, Sangwan S, Sharma U, Thukral BB, Saxena NC. Aggressive adenocarcinoma of gallbladder with distant metastases and venous thrombosis at initial presentation Indian J Radiol Imaging 2006;16:499-501.  Back to cited text no. 2
    
3.Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder Carcinoma: Radiologic Pathologic Correlation. Radiographics 2001;21:295-314.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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1 Porcelain Gallbladder: A Benign Process or Concern for Malignancy?
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[Pubmed]



 

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