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文献考察：陶器様胆嚢（porcelain gallbladder）
１）【肝胆膵領域における腫瘍性病変の画像と病理】 腫瘍に関連する肝・胆・膵の画像と病理 胆道 陶器様胆嚢
Author：小山祐康(東京女子医科大学 臨床検査科), 土岐文武
Source：肝・胆・膵(0389-4991)49巻5号 Page835-837(2004.11)
要旨：陶器様胆嚢（porcelain gallbladder）あるいは磁器様胆嚢（china gallbladder）とは，胆嚢壁に広範な石灰化をきたし，外観および硬度が陶器様に変化した病態である．本邦では現在までに200例あまりが報告されている．男女比は約1：4と明らかに女性に多く，平均年齢は約60歳で高齢者に多い．80％の症例で胆石が併存し，90％前後に胆嚢管の閉塞が認められることから病因として，胆嚢管閉塞説，慢性炎症説，慢性刺激説，カルシウム代謝異常説などが考えられている・臨床症状としては右季肋部痛または心窩部痛が60％程度に，腹部不定愁訴や発熱が15％程度に，無症状例が15〜20％に認められる．ＣＴでは肥厚した胆嚢壁にリング状あるいはドーナツ状の石灰化像が典型的な像とされているが，石灰化が一部でしかも不均一な石灰化例では確定診断は困難なことがある．本症は胆石の合併率が高く，胆嚢管閉塞例では胆嚢機能の消失している症例が多いこと，また胆嚢癌の合併率が高いことから症状の有無にかかわらず外科的手術が治療の原則とされてきた．しかし，最近の米国での大規模な2つの調査では，胆嚢癌合併率はそれぞれ0％，5％と報告されている（下記文献）．本症の手術適応についは再検討が必要である．
２）陶器様胆嚢例に胆嚢癌は１例も発見されない，胆嚢癌に壁の石灰化があったのは１例もない．
Am Surg. 2001 Jan;67(1):7-10.
Porcelain gallbladder is not associated with gallbladder carcinoma.
Towfigh S, McFadden DW, Cortina GR, Thompson JE Jr, Tompkins RK, Chandler C, Hines OJ.
The surgical management of porcelain gallbladder is based on studies performed in 1931 and 1962, which indicated a correlation between porcelain gallbladder and carcinoma. We sought to evaluate the characteristics of patients with porcelain gallbladder and the risk for gallbladder carcinoma. The medical records of 10,741 cholecystectomies performed between 1955 and 1998 were reviewed and recorded. The pathology slides were evaluated for evidence of calcification and gallbladder carcinoma. Fifteen (0.14%) of 10,741 specimens were porcelain gallbladders. Ten patients (67%) had symptoms suggestive of biliary colic or cholecystitis. Five (33%) were asymptomatic and diagnosed incidentally. All specimens demonstrated chronic cholecystitis and partial calcification of the gallbladder wall. Nine (60%) had cholelithiasis. None had gallbladder carcinoma by recent review of pathologic material. During this same period 88 (0.82%) patients had gallbladder carcinoma, none of which showed calcification of the wall. This report represents the largest modern review of porcelain gallbladders. No carcinoma was identified among patients with porcelain gallbladder. In addition no patient with gallbladder carcinoma had calcified gallbladder. With a better understanding of the natural history of the porcelain gallbladder the current management of these patients may change.PMID: 11206901
３）selective mucosal wall calcification 例で7%に胆嚢癌が発見された，diffuse intramural calcification例では胆嚢癌は発見されなかった．陶器様胆嚢は従来言われたほど胆嚢癌の合併は多くない．
Surgery. 2001 Jun;129(6):699-703.
Carcinoma in the porcelain gallbladder: a relationship revisited.
Stephen AE, Berger DL.
BACKGROUND: Gallbladder cancer is the most common biliary tract malignancy. Calcification of the gallbladder wall is reported to be associated with gallbladder cancer. In the literature, the incidence is quoted to be between 12% and 61%. This study aims to clarify the risk of cancer in a calcified gallbladder. METHODS: The charts and pathology reports at the Massachusetts General Hospital were reviewed, and patients with either gallbladder cancer or a calcified gallbladder were included in the study. The Fisher exact test was used to test for the association between cancer and gallbladder wall calcifications. RESULTS: From 1962 to 1999, there were approximately 25,900 gallbladder specimens analyzed at the Massachusetts General Hospital. There were 150 patients with gallbladder cancer and 44 patients with calcified gallbladders. Two types of calcified gallbladders were noted: those with complete intramural calcification (n = 17) and those with selective mucosal calcification (n = 27). The incidence of cancer arising in a gallbladder with selective mucosal wall calcification was approximately 7%. There was a significant association between gallbladder cancer and selective mucosal calcification with an odds ratio of 13.89 (P =.01). There were no patients with diffuse intramural calcification and cancer. CONCLUSIONS: A calcified gallbladder is associated with an increased risk of gallbladder cancer, but at a much lower rate than previously estimated. The incidence of cancer depends on the pattern of calcification; selective mucosal calcification poses a significant risk of cancer whereas diffuse intramural calcification does not.PMID: 11391368
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