Porcelain gallbladder refers to the condition in which the inner gallbladder wall is encrusted with calcium. The wall becomes brittle, hard, and often takes on a bluish hue. Other names for this condition are calcified gallbladder, calcifying cholecystitis, and cholecystopathia chronica calcarea. It is usually found incidentally on plain abdominal x-rays or other imaging because most patients are asymptomatic. The extent of gallbladder wall involvement varies from the presence of a single calcified plaque adhered to the mucosal layer to total full-thickness replacement of the tissue of the entire gallbladder wall with calcium. The latter description is the more classic finding when discussing porcelain gallbladder . Porcelain gallbladder is very rare, and in the past, it was believed to be associated with gallbladder malignancy. However, the current opinion is that the risk of malignancy is small. Porcelain gallbladder is often seen in elderly females and may sometimes become obvious on a plain x-ray.

Cholelithiasis (gallstones) is a frequent disease, with an estimated annual risk of 1 to 4% of presenting clinical manifestations. It mainly results from imbalanced bile composition: cholesterol oversaturation, low levels of bile acids and gallbladder stasis resulting in the formation of gallstones. Two main types of gallstones exist: cholesterol gallstones (the most frequent), and pigment gallstones. The risk factors for lithiasis are multiple: age, female sex, rapid weight fluctuations, certain medical treatments, pregnancy, and a number of pathologies (diabetes, obesity, cirrhosis, Crohn's disease…). While lithiasis is often asymptomatic, approximately 20% of patients present with biliary colic or can develop severe complications: acute cholecystitis, stone migration, cholangitis or acute pancreatitis. In the event of symptomatic complications, laparoscopic cholecystectomy is the standard treatment. In the absence of clinical evidence, however, a conservative attitude is generally recommended, except in situations involving a risk of malignant transformation (large gallstones, adenomatous polyps, incomplete porcelain gallbladder…). Even though surgical technique is codified in terms of Critical View of Safety (CVS), the role of intraoperative cholangiography remains debated. Acute cholecystitis is managed according to the degree of severity and taking into account the Tokyo recommendations; available options range from early surgery to percutaneous drainage in the setting of major surgical risk. Management in pregnant women, elderly patients and cirrhotic patients, is individualized insofar as these populations present a risk of complications needing a personalized therapeutical approach.

Porcelain gallbladder (PG), characterized radiographically by gallbladder wall calcification, is a rare condition with significant clinical importance due to its association with gallbladder cancer (5-22%). This review explores the epidemiology, pathophysiology, and molecular mechanisms of PG development. Strong correlation with gallstones (> 60%) establishes cholelithiasis as the primary risk factor, with female sex, advanced age, and metabolic disorders also contributing significantly. The pathogenesis involves sustained inflammation, leading to fibrosis, scarring, and ultimately calcium deposition. At the molecular level, pro-inflammatory cytokines, macrophage activation, and fibroblast differentiation ultimately result in collagen deposition and calcification. Estrogen contributes to female predominance through reduced gallbladder motility and increased cholesterol secretion via ESR1, ESR2, and GPER1 receptors. Postmenopausal women remain at risk despite lower estrogen levels due to antioxidant system changes and structural alterations from previous pregnancies. Emerging evidence suggests roles for Helicobacter pylori and other urease-producing bacteria in PG development. The relationship between calcification patterns and malignancy remains controversial, with incomplete calcification potentially carrying higher cancer risk. This review synthesizes current knowledge while highlighting areas requiring further investigation. Evaluation of the urinary bladder for calcification and malignancy is advised when PG is detected, to explore potential associations for future research.

Background: Gallbladder cancer (GBC) is a highly lethal malignancy that is often asymptomatic in its early stages and difficult to treat once clinical symptoms appear. Although established risk factors include female sex, gallstones, and chronic biliary inflammation, other clinical contexts associated with GBC remain insufficiently characterized. Multiple primary malignancies (MPMs), in which more than one primary cancer develops in the same individual, have recently attracted attention; however, their relationship with GBC has only rarely been examined. In this study, we aimed to clarify the clinical features of MPM-related GBC and explore its implications for early detection. Methods: We retrospectively compared 22 patients with GBC associated with other malignancies (MPM-positive GBC) and 16 patients with GBC alone (MPM-negative GBC). Clinical characteristics, major risk factors, tumor presentation, and imaging findings were evaluated. Special attention was paid to the sequence of cancer development and the diagnostic utility of contrast-enhanced ultrasonography (CEUS). Results: In all MPM-positive cases, GBC occurred as a second primary malignancy, most commonly following gastrointestinal cancers (12/22). Gallstones were significantly less frequent in the MPM-positive group than in the MPM-negative group (2/22 vs. 6/16). The MPM-positive group showed a slight male predominance (12 males and 10 females). Neither pancreaticobiliary maljunction nor porcelain gallbladder was identified in either group. CEUS was useful for both the detection and qualitative diagnosis of GBC in all patients. Conclusions: MPM-related GBC frequently develops as a second primary malignancy in patients with prior gastrointestinal cancer and may arise in the absence of classical risk factors. Careful long-term surveillance after cancer treatment is therefore essential for identifying second primary GBC at a potentially resectable stage. The combined use of ultrasonography and CEUS may facilitate earlier and more accurate diagnosis in this clinical setting.

Giant gallstones are a rare phenomenon that may pose technical challenges for surgeons. We describe the case of an 81-year-old female who presented to our regional health service with acute cholecystitis and a computed tomography (CT) scan demonstrating a possible porcelain gallbladder. Her index presentation was conservatively managed with intravenous antibiotics due to body habitus and concerns for the porcelain gallbladder, with a good clinical response. She subsequently underwent an elective laparoscopic cholecystectomy which was converted to an open approach due to technical challenges. She was found to have a chronically inflamed gallbladder containing a giant gallstone. We report our successful management of a chronically inflamed gallbladder involving a giant gallstone. We also explore diagnostic considerations and surgical approaches to tackle the technical challenges we encountered in this case.

Introduction Laparoscopic cholecystectomy has revolutionized the surgical approach to gallbladder removal and has since then become the gold standard. Despite the significant benefits of laparoscopic cholecystectomy, complications requiring hospital readmission remain a cause for morbidity. The nationwide audit aims to assess the 30-day readmission rate following cholecystectomy in Malta and compare these findings to guidelines recommending a readmission rate of less than 10%. Method All patients, male and female, who underwent a cholecystectomy in the year of 2023 were identified from the hospital operating theater records. After compiling the patient list and obtaining ethical approval, hospital records, including electronic discharge summaries and radiological investigations, were reviewed to collect data on demographics, indication for cholecystectomy, and cause for readmission. Results In 2023, a total of 288 patients underwent cholecystectomy at Mater Dei Hospital. Of these, 168 (58.3%) patients were female and 120 (41.7%) were male, with the majority falling within the 50-59 age range. Most surgeries, n = 282 (97.9%), were elective, with only six patients requiring emergency intervention. Cholecystectomy was performed in the majority of cases as laparoscopy n = 279 (96.9%), one surgery was performed as an open procedure (<1%), and eight cases (2.8%) were converted from laparoscopic to open surgery. The most common indication for cholecystectomy was cholecystitis (n=138, 47.9%), cholelithiasis (n=89, 30.9%), and pancreatitis (n=45, 15.6%). Two patients had cholecystectomy for malignancy (n = 2, 0.69%). The remaining patients had surgery secondary to porcelain gallbladder (n = 2), gallbladder polyps (n = 7), rupture (n = 1), adenomyosis and dysmotility (n = 4), collectively making up 4.86%. Preoperative imaging with magnetic resonance cholangiopancreatography (MRCP)/endoscopic retrograde cholangiopancreatography (ERCP) was conducted in 175 patients (60.7%), while 113 patients (39.2%) did not undergo any form of imaging prior to surgery. Regarding postoperative outcomes, 84 patients (29.1%) were discharged on the same day as their procedure, with the majority, n = 128 (44.4%), discharged the following day. N = 50 (17.36%) patients stayed in hospital for 2-5 days, n = 21 patients stayed in hospital for 6-10 days (7.30%). Only n = 5 (1.74%) patients stayed in the hospital for > 10 days. In total, 13 patients (4.5%) were readmitted, with the most common reasons being surgical complications, n = 9 (69.2%). Other causes of readmission included medical complications, which account for n = 4 (30.8%) of the readmitted cohort. Conclusion The 30-day readmission rate stood at 4.5%. This rate should be considered in light of the fact that the majority of patients were discharged just one day after surgery.

Porcelain Gallbladder (PGB) is a condition marked by extensive calcification and thickening of the gallbladder wall. PGB is extremely rare in dogs. The exact mechanism of PGB remains unclear. However, chronic cholecystitis and factors such as biliary hyperplasia, mucin hypersecretion, and cystic duct obstruction can lead to fibrosis and calcification of the gallbladder wall, potentially resulting in PGB. A 13-year-old spayed female Shih Tzu presented with anorexia, lethargy, vomiting, and weight loss. Physical exams showed mild epigastric pain. Blood tests indicated mild alanine aminotransferase (ALT) elevation, significant alkaline phosphatase, and gamma-glutamyl transferase (GGT) increases. Hyperlipidemia, hypercholesterolemia, and elevated canine pancreatic lipase (cPL) were also noted. Diagnostic imaging revealed extensive gallbladder wall calcification and thickening, choleliths, mild bile duct dilation, pancreatitis, and duodenitis. Cholecystectomy was performed, and symptomatic treatment for pancreatitis and duodenitis was administered. Histopathological examination is essential for confirming PGB by identifying calcification of the gallbladder wall. Histopathological examination of the gallbladder revealed severe papillary hyperplasia, mucin hypersecretion, multiple ulcers, diffuse calcification, and fibrotic changes. These findings confirmed the diagnoses of gallbladder mucocele and PGB. Postoperatively, biochemical markers normalized or significantly decreased, with clinical improvement observed. This study presents the rare occurrence of PGB in dogs and emphasizes the importance of appropriate veterinary intervention for improving clinical outcomes.

Porcelain gallbladder is a rare condition characterized by an extensive calcification of the gallbladder wall. It is associated with an increased risk of gallbladder cancer and elevated levels of tumor marker CA19-9, which is typically seen in pancreatic and biliary cancers. We present a case of a 60-year-old woman who presented with upper abdominal pain and nausea. Imaging revealed both a porcelain gallbladder and common bile duct stones. Initially, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) for the removal of the common bile duct stones. Notably, following the removal of the stones, the patient's CA19-9 levels were significantly elevated, reaching 6076 U/mL. Subsequently, she underwent a laparoscopic cholecystectomy. Histopathological examination and immunostaining for CA19-9 were performed on the resected specimen. Histopathology revealed marked fibrosis, calcification, and xanthogranulomatous inflammation of the gallbladder wall without evidence of malignancy. Immunostaining showed strong CA19-9 positivity in the inflamed gallbladder mucosal epithelium. Postoperatively, the patient's CA19-9 levels returned to normal (17 U/mL). This case highlights that a benign porcelain gallbladder can present with abnormally high CA19-9 levels, potentially mimicking malignancy. Reports of CA19-9 elevation in porcelain gallbladder are limited, and in most cases, significant CA19-9 elevation has been associated with malignancy. This case also demonstrates that benign conditions such as biliary obstruction, chronic inflammation, and xanthogranulomatous cholecystitis can cause significant elevations in CA19-9 levels. Therefore, careful differentiation and comprehensive evaluation are crucial for accurate diagnosis and appropriate management in such cases.

Commonly referred to as a "porcelain gallbladder (PGB)," gallbladder calcification is usually asymptomatic. It is observed that chronic inflammation of the gallbladder can occur as a result of another underlying condition, specifically gallstone disease. In the past, there was a belief that PGB had a correlation with gallbladder cancer, with an incidence rate of 30%. However, recent studies have indicated that the rate is only 5%-22%. Patients diagnosed with PGB, who are deemed to be at an elevated risk of developing cancer may undergo prophylactic cholecystectomies. However, recent research indicates that a subset of these patients may potentially avoid this surgical intervention. As a result of the increased risk of gallbladder cancer, and the difficulty of holding and retracting the gallbladder, laparoscopic cholecystectomy was not often recommended for patients with PGBs in the past. However, with the advancement of technology laparoscopy is now a choice for such difficult cases. Here we report a case of PGB in a 55-year-old female patient who complained of intermittent pain in the right upper abdomen with vaginal discharge. She was successfully managed laparoscopically.

Benign tumors of the liver and biliary tract are rare entities, and some of them require surgical management to prevent their malignant transformation. Tumors from the biliary tract with malignant potential are treated either by hepatic resection, for mucinous cystic neoplasm and ciliated hepatic foregut cysts, or by biliary resections, for biliary papillary neoplasm and type I and IV choledochal cysts. The pathologies requiring prophylactic cholecystectomy are polyps larger than 10 mm, porcelain gallbladder and pancreaticobiliary maljunction. Finally, hepatocellular adenoma over 5cm, occurring in male patients, or exon 3 mutated beta-catenin, should lead to prophylactic resection by hepatic segmentectomy. This article describes these different pathologies and their management.

Gallbladder carcinoma represents the most aggressive biliary tract cancer and the sixth most common gastrointestinal malignancy. The diagnosis is a challenging clinical task due to its clinical presentation, which is often non-specific, mimicking a heterogeneous group of diseases, as well as benign processes such as complicated cholecystitis, xanthogranulomatous cholecystitis, adenomyomatosis, porcelain gallbladder or metastasis to the gallbladder (most frequently derived from melanoma, renal cell carcinoma). Risk factors include gallstones, carcinogen exposure, porcelain gallbladder, typhoid carrier state, gallbladder polyps and abnormal pancreaticobiliary ductal junction. Typical imaging features on CT or MRI reveal three major patterns: asymmetric focal or diffuse wall-thickening of the gallbladder, a solid mass that replaces the gallbladder and invades the adjacent organs or as an intraluminal enhancement mass arising predominantly from the gallbladder fundus. The tumor can spread to the liver, the adjacent internal organs and lymph nodes. Depending on the disease stage, surgical resection is the curative treatment option in early stages and adjuvant combination chemotherapy at advanced stages. The purpose of this scientific paper is to fully illustrate and evaluate, through multimodality imaging findings (CT and MRI), different presentations and imaging scenarios of gallbladder cancer in six patients and thoroughly analyze the risk factors, patterns of spread and differential diagnosis regarding each particular case.

Gallbladder (GB) carcinoma, although relatively rare, is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis. It is closely associated with cholelithiasis and long-standing large (> 3 cm) gallstones in up to 90% of cases. The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes, GB wall calcification (porcelain) or mainly mucosal microcalcifications, and GB polyps ≥ 1 cm in size. Diagnosis is made by ultrasound, computed tomography (CT), and, more precisely, magnetic resonance imaging (MRI). Preoperative staging is of great importance in decision-making regarding therapeutic management. Preoperative staging is based on MRI findings, the leading technique for liver metastasis imaging, enhanced three-phase CT angiography, or magnetic resonance angiography for major vessel assessment. It is also necessary to use positron emission tomography (PET)-CT or [18]F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake. Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6% of cases. Multimodality treatment is needed, including surgical resection, targeted therapy by biological agents according to molecular testing gene mapping, chemotherapy, radiation therapy, and immunotherapy. It is of great importance to understand the updated guidelines and current treatment options. The extent of surgical intervention depends on the disease stage, ranging from simple cholecystectomy (T1a) to extended resections and including extended cholecystectomy (T1b), with wide lymph node resection in every case or IV-V segmentectomy (T2), hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y, and adjacent organ resection if necessary (T3). Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery, but much attention must be paid to avoiding injuries. In addition to surgery, novel targeted treatment along with immunotherapy and recent improvements in radiotherapy and chemotherapy (neoadjuvant-adjuvant capecitabine, cisplatin, gemcitabine) have yielded promising results even in inoperable cases calling for palliation (T4). Thus, individualized treatment must be applied.