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).With the advancement of imaging modalities, plain film radiology is increasingly overlooked. However, its importance cannot be denied in investigating acute abdominal conditions and diagnosing various causes of calcifications, which can be pathognomonic of certain chronic abdominal diseases. Although plain abdominal radiographs are often diagnostic in depicting majority of renal stones and calcifications of blood vessels and lymph nodes, these rarely demonstrate gallbladder (GB) stones and its mural calcification.Porcelain GB is a complete or partial calcification of the entire GB wall thickness or its mucosal layer that is visualized on plain abdominal X-ray as a thin curvilinear or speckled calcification in right upper quadrant (RUQ) or more precisely the gallbladder fossa. It is often associated with gallstones, which are usually radiolucent. Ultrasound scan (USS) can demonstrate an echogenic thick shadowing in the GB fossa making it difficult to differentiate from emphysematous cholecystitis. Computed tomography (CT) scan with threedimensional (3-D) reconstruction is considered highly efficient in diagnosing this condition. Case ReportsWe present three cases of porcelain GB with abdominal pain. The first case was a middle-aged Mediterranean male patient who presented with intermittent postprandial pain on several occasions in A&E. His plain abdominal film revealed a faint thin curvilinear calcification in RUQ. Subsequently, he had an abdominal CT scan that confirmed the diagnosis of porcelain GB by demonstrating a heavily calcified neck and body of the GB. Keywords► porcelain gallbladder ► cancer ► diagnosis ► mural calcification AbstractBackground Porcelain gallbladder (GB) is a rare but potentially premalignant condition with minimal symptoms. Accident and Emergency (A&E) departments often tend to investigate abdominal pain through plain radiographs, which are occasionally reported by radiologists, thereby leaving behind few uncommon conditions, such as porcelain gallbladder unreported. Objectives We present three cases of porcelain GB in which initial diagnosis was not considered due to the presence of various other calcifications in the upper abdomen. Methods In A&E, plain abdominal X-rays were routinely performed in all three patients to investigate nonspecific postprandial abdominal pain. Although GB calcification was easy to diagnose on plain films, it was initially overlooked to be a cause of the symptoms and later was diagnosed on abdominal CT scans, performed for further evaluation. Results Abdominal X-rays revealed thin curvilinear calcification in the GB wall, partially calcified neck and body, and gall stones. CTscan confirmed porcelain GB in all three patients. Conclusion Gallbladder mural calcification is a rare cause of nonspecific abdominal pain, which is often overlooked on plain abdominal X-rays causing missed diagnosis. The association of porcelain GB with adenocarcinoma entails special emphasis on timely diagnosis and prompt management.

The decreased bone mineral density and compromised bone strength predispose individuals to skeletal osteoporosis. Both prostate cancer and bone metastasis caused by cancer invasion have remained a great challenge to researchers. With the advancement in the fields of biochemistry and biomechanics, the molecular mechanisms that make prostate cancer metastasize to bone have recently been identified, and they provide new molecular targets for drug development. Many biochemical by-products have been identified to help in understanding the interaction between the bone and the tumor. Enhanced clinical management of patients with bone metastases was reported during the past decade; however, the anticipated risk and the response to the therapy are still challenging to assess. In this review, the key players that play a dominant role in secondary osteoporosis are addressed. An attempt is made to provide the readers with a clear understanding of the communication pathways between each of the cell types involved in this vicious cycle. Furthermore, the role of Wnts, sclerostin, RANKL, PTHrP, and their respective clinical studies are addressed in this study.

Entrapment of the left renal vein between superior mesenteric artery (SMA) and aorta can be asymptomatic or present as microscopic hematuria and orthostatic proteinuria. It can be associated with other abdominal vascular compression syndromes and duodenal obstruction. We present a 62-year-old Caucasian male patient with nutcracker phenomenon and SMA syndrome secondary to rectal cancer associated cachexia. Computed tomographic angiography is a non-invasive diagnostic modality which depicts it in great details. Its early clinical suspicion and radiologic assessment help in patient management to avert possible complications such as blood loss in already debilitating patients such as ours.