title: A porcelain gallbladder and a rapid tumor dissemination.
abstract: BACKGROUND
  Porcelain gallbladder is a very rare entity that consists of a calcification of the gallbladder wall, and is associated with carcinoma in 12.5-62% of patients, although recent studies suggest weaker association.
  
  
  METHODS
  We describe an 80-year-old woman who presented with colicky abdominal pain in the right upper quadrant, radiating to the back and associated with vomiting. Physical examination revealed jaundice, murphy's sign was negative. Hepatic-biliary tract ultrasound revealed porcelain gallbladder, she was referred to the surgical team for a scheduled cholecystectomy. A month later, she presented diffuse abdominal pain. Imaging studies showed a disseminated process affecting liver's segments, capsule, and hilum; and lungs. An aggressive surgical treatment was dismissed, and was referred to the oncology department.
  
  
  CONCLUSIONS
  There is controversy in the harboring risk of malignancy of the porcelain gallbladder. While it seems that the current data points towards a lower risk of degeneration, it is also demonstrated that patients with gallbladder wall calcifications are indeed statistically at risk of gallbladder cancer. Laparoscopic cholecystectomy has become a safe and efficient approach recommended for patients with gallbladder symptoms directly related or unrelated to gallbladder wall calcifications. In this case, a pathological gallbladder, very quickly evolved into an inoperable tumor with a poor prognosis.
  
  
  CONCLUSIONS
  This report heightens that with US evidence of porcelain gallbladder, an urgent CT scan should be carried out to assess an underlying malignancy, and a simple cholecystectomy should be done urgently rather than on a routine elective list to prevent possible malignant change if possible.
authors.affiliation: Department of General Surgery, University Clinic Hospital of Valladolid, Spain.
authors.forename: Juan-Ramón
authors.initials: JR
authors.lastname: Gómez-López
authors.affiliation: Department of General Surgery, University Clinic Hospital of Valladolid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: De Andrés-Asenjo
authors.affiliation: Department of Cardiac Surgery, University Clinic Hospital of Valladolid, Spain.
authors.forename: Christian
authors.initials: C
authors.lastname: Ortega-Loubon
keywords: Gallbladder calcification; Gallbladder carcinoma; Porcelain gallbladder