Vésicule porcelaine; cancer de la vésicule biliaire; lithiase vésiculaire
Nous avons rapporté le cas d’une patiente de 68 ans, admise au service de Chirurgie I du CHU de Rabat pour masse radio opaque de l’hypochondre droit, chez qui le diagnostic de vésicule porcelaine a été posé, et qui a bénéficié d’une cholécystectomie.
La vésicule porcelaine est une pathologie rare, prédominant chez la femme âgée.
Elle est associée dans 95 % des cas à une lithiase biliaire, et est souvent découverte fortuitement.
Plusieurs hypothèses ont été émises quant à la physiopathologie de la calcification vésiculaire, comme le rôle de la cholécystite chronique ou de la lithiase vésiculaire, mais aucune n’a été retenue comme sure.
Si la clinique est souvent asymptomatique ou se réduit aux symptômes de la maladie lithiasique, le diagnostic est établi grâce a la paraclinique. L’ASP trouve une image calcifiée au niveau de l’hypochondre droit, et l’échographie et la Tomodensitométrie confirment le diagnostic en montrant une calcification de toute la paroi vésiculaire.
La revue de la littérature récente a montré que des études rétrospectives remontant a plus de quarante ans n’ont objectivé aucun cas de cancer vésiculaire sur une vésicule porcelaine. Par contre, les vésicules partiellement calcifiées ont plus de chance de dégénérescence maligne.
Ainsi, la conduite à tenir pratique en cas de découverte d’une vésicule porcelaine est la même qu’en cas de lithiase biliaire : si le patient est asymptomatique, l’abstention est de mise ; s’il existe déjà des symptômes ou des complications, une cholécystectomie est à envisager.
Summary
We studied the case of a 68 years patient that was admitted in the visceral surgical emergency service of CHU in Rabat for calcified mass of the right upper quadrant,where the diagnosis of porcelain gallbladder was probable and who benefit from a cholecystectomy.
Porcelain gallbladder is a rare pathology, most common for old women. It’s related in 95% of the cases to the biliary lithiasis, and often fortuitously discovered.
Many hypotheses were raised concerning the physiopathology of the calcification of the gallbladder wall, like the role of the chronic cholecystitis or lithiasis, but none was considered as sure.
If the clinic is often asymptomatic or is reduced to the lithiasic disease symptoms, the diagnostic is done thanks to the para-clinic. The abdominal plain radiography finds calcified image in the right upper quadrant and the echography confirm the diagnosis by showing the calcification of all the gallbladder wall.
This calcification can be done in focal manner in the mucous folds, or in homogenous way and extended on the entire gallbladder wall: it is the porcelain gallbladder.
Therefore, same practice to follow either case of discovering a porcelain gallbladder or biliary lithiasis: If the patient is asymptomatic, abstention is probable, if already symptoms or difficulties exist, cholecystectomy is to be considered.
[1] EMC Anatomie des voies biliaires extra hépatiquesTechniques chirurgicales- Appareil digestif [40-900](1990)
Y Bouchet, JC Passagia, JF Lopez
[2] Rouvière, Anatomie des lymphatiques de l’homme, Masson, Paris (1932)
[3] Physiopathologie, épidémiologie et histoire naturelle de la lithiase biliaire EMC Hépatologie [7-047-1-10](1986)
S Erlinger
[4] Jones RS
Carcinoma of the gallbladder. Surg Clin North Am 1990; 70:1419-28
[5] Tanaka K, Nishimura A, et al
Cancer of the gallbladder associated with anormalous function of the pancreatoblilary ducts system without bile duct dilatation Br J Surg 1993 ;80 :622-4
[6] Valls C, Guma A, Puig I, Sanchez A, Andia E, Serrano T, et al.
Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 2000;25:490-6.
[7] Tillich M, Mischinger HJ, Preisegger KH, Rabl H, Szolar DH.
[8] Yamamoto M, Najako S, Tahara E
Endocrine cells an lysozyme immunoreactivity. Arch Pathol Lab Med1986;110:920-7
[9] Csendes A, Becerra M, Burdiles P et al.
Bacteriological studies of bile from the gallbladder in patients with carcinoma of the gallbladder, cholelithiasis, common bile duct stones, and no gallstones. Eur J Surg 1994; 160:363-7
[10] Shapiro R.
Fixed effects of the gallbladder wall and aenomyomatosiss. Surg Gynecol Obstet 1973; 136:745-52
[11] Khan SA, Davidson BR, Goldin R, Pereira SP, Rosenberg WM, Taylor-Robinson SD, et al.
Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002;51:VI1-9.
[12] Gores GJ.
Early detection and treatment of cholangiocarcinoma. Liver Transpl 2000;6:S30-4.
[13] Ramage JK, Donaghy A, Farrant JM, Iorns R, Williams R.
[14] Carpelan-Holmstrom M, Louhimo J, Stenman UH, Alfthan H, Haglund C. CEA, CA 19-9 and CA 72-4 improve the diagnostic accuracy in gastrointestinal cancers. Anticancer Res 2002;22:2311-6.
[15] Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 2003;139:547-57.
[16] Saini S.
Imaging of the hepatobiliary tract. N Engl J Med 1997;336:1889-94.
[17] Towfight S, McFadden D, Galen R Cortina et al
Porcelain gallbladder is not associated with gallbladder carcinoma. Am Surg 2001;67:7-10
[18] Stephen AE, Berger DL
Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery 2001;129:699-703
[19] N Casteel HB, Williamson SL, Golladay ES, Fiedorek SC
Porcelain gallbladder in a child: a case report and review. Journal of pediatrics surgery 1990;25:1302-03
[21] Sheth S, Bedford A, Chopra S
Primary gallbladder cancer: recognition of risk factors and the role of prophylactic cholecystectomy; Am J Gastroenterol 2000;95:1402-1408
[22] Florken H
Die porzellangallenblase (cholecystopathia chronica calcarea). Deutche Ztschr Chir 1929;216:264-70
[23] Ashur H, Siegal B and al
Calcified gallbladder (porcelain gallbladder) Arch Surg 1978; 113:594-6
[24] Kirklin BR.
Report of the past 7 years work at Mayo Clinic. 11/3/31
[25] RH Kazmierski.
Primary adenocarcinoma of the gallbladder with intramural calcification, Am J Surg 1951;82:248-50
[26] Polk HC.
Carcinoma and the calcified gallbladder. Gastroenterology 1966;50:582-585
[27] Berk RN , Armabuster TG, Salzstein SL.
[29] Letter:Porcelain gallbladder and cancer: Ethnicity explains a discrepant literature? Am Journal of Medecine 2007; 120:e17-e18
[30] Cornell CM, Clarke R.
Vicarious calcifications involving the gallbladder. Ann Surg 1959; 149:267-72
[31] Tseung-Chun Lee, Kao-Lang Liu and al
Diagnososing porcelain gallbladder American Journal of medicine 2005;11:1171-2
[32] Takeda K, Sekido H and al
Porcelain gallbladder complicated with pancreas divisum. J Hepatobiliary Pancreat Surg; 2006, 13:580-583
[33] Baker Stephen R. The abdominal plain film. Norwalk5CT; Appleton and Lange, 1990.p61-3, 271-3
[34] [34]Tazuma S, Kajiyama G
Carcinogenesis of malignant lesions of ths gallbladder. The impact of
chronic inflammation an gallstones. Langenbecks Arch Surg
2001;386:224-229
[36] Weiner PL, Lawson TL
The radiology corner. Porcelain gallbladder. Am J Gastroenterol 1975;64:224-7
[37] Shimizu M, Junro Miura and al. J Clin Gastroenterol 1989;11(4):471-6 Porcelain gallbladder : relation between its type by ultrasound and incidence of cancer
[38] Nakashima H, Tanaka Y
Hepatobiliary and pancreatic :Porcelain gallblader. Journal of
gastroenterology and hepatology. 2002; 17:1228
[39] CH Thietof et HW Van Es
Image of the month. Porcelain gallbladder, Gastroenterology 199;117:760
[40] F Lacaine
Faut-il opérer les vésicules porcelaine par laparoscopie?; Journal de chirurgie 2003 :140 :115-119
[41] M Gonzalez , C Toso, G Zufferey, T Roiron et al Quand faut il réaliser une cholécystectomie ?