Low-Grade Dysplastic Intracholecystic Papillary Neoplasia: A Case Report

Abstract

Patient: Female, 71-year-old Final Diagnosis: Hepatic epithelioid angiomyolipoma Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Pathology • Surgery Objective: Rare disease Background: The World Health Organization classification of premalignant gallbladder lesions includes adenomas, intraductal papillary neoplasms, biliary intraepithelial neoplasia, and intracystic papillary neoplasms. Noninvasive neo-plastic lesions >1 cm that originate from the pancreatobiliary system are defined as intraductal papillary neoplasia when they occur in the biliary ducts. The clinical and pathological features of preinvasive lesions arising in the gallbladder are not yet well defined. However, the most widely accepted classification is that of intracholecystic papillary neoplasm (ICPN). Case Report: We present the case of a 71-year-old woman referred to a General Surgery outpatient clinic for suspicious findings on imaging of the gallbladder, namely irregular infundibular parietal thickening. The patient underwent a laparoscopic cholecystectomy and histological examination revealed a thickened gallbladder with mucosa partially surrounded by ICPN with an intestinal pattern and some foci of low-grade dysplasia but no foci of high-grade dysplasia or invasive neoplasia. At follow-up at 30 months, the patient remains clinically well, with no changes visible on computed tomography scan. Conclusions: ICPN of the gallbladder appears to be part of a spectrum of alterations encompassing bile duct or pancreatic lesions. Although it is uncommon, more than half of the lesions are known to have foci of invasive neoplasia at the time of diagnosis. Despite that, the prognosis for these neoplasms is more favorable than for gallbladder neoplasia that originates from another type of lesion. Pathological study of ICPN is essential to define the main characteristics that impact prognosis and survival in these patients.

Biliary Intraepithelial Neoplasia With Gallbladder Adenoma and Cirrhosis: A Case Report

“…The prognosis for ICPN is better than that for invasive gallbladder carcinomas, with three-year survival averaging 90% for lesions with no foci of invasion versus 60% for those with foci of invasion [18]. The presence of low-grade dysplasia of ICPN with no evidence of invasive foci has previously been managed without intervention or additional testing [19]. However, our patient met the indications for resection and therefore underwent cholecystectomy similar to prior reported cases [15].…”

Pathologies of Precursor Lesions of Biliary Tract Carcinoma

“…The majority of high-grade ICPN contains variable amounts of low-grade components ( Figure 3 C), and transition from LGD to HGD in ICPN is evident in many cases [ 18 , 176 ]. ICPNs composed entirely of LGD are rare [ 188 ]. As in IPNB, type 1 and 2 subclassifications [ 7 , 38 ] are also applicable in ICPN, with one third- and two-thirds of ICPNs subclassified into types 1 and 2, respectively [ 176 ].…”

Papillary Neoplasms of the Gallbladder and Extrahepatic Bile Ducts: A Report of Two Cases With Associated Invasive Carcinoma

“…Typically, when there is no obstruction, particularly in the cystic duct, laboratory results tend to be normal. On imaging, the gallbladder commonly exhibits a thickening of its wall and the presence of an intra-luminal mass [ 9 ].…”

“…ICPNs are precursor lesions for gallbladder adenocarcinomas that could be associated with low-grade dysplasia, high-grade dysplasia, or occasionally, invasive adenocarcinoma [ 9 ]. Therefore, a meticulous pathological analysis is crucial for accurately diagnosing these lesions and assessing their prognosis.…”