Gallbladder papillary neoplasms share pathological features with intraductal papillary neoplasm of the bile duct

Clinicopathological Study of Intracholecystic Papillary Neoplasm of the Gall Bladder: a Case Series

Intracholecystic papillary neoplasm (ICPN) is defined as a grossly visible, mass-forming, non-invasive epithelial neoplasm arising in the mucosa and projecting into the lumen of the gallbladder. Since the northeastern part of India has a high incidence of gall bladder cancer, ICPN being a precursor lesion is important to be diagnosed on biopsies. Nine cases with Intracholecystic papillary neoplasm of the gall bladder were studied. The clinicoradiological findings of these patients, gross and microscopic findings of H&E-stained sections were recorded and immunohistochemistry was done for Ki 67. The median age of diagnosis was 60 years with a male-to-female ratio 1:3.5. The most common presenting symptom was pain abdomen, other symptoms included vomiting, weight loss, and jaundice. Associated gall stones were seen in 6 of the cases. Radiological investigations revealed gall stones in 6 cases, intraluminal mass lesion/polyp was reported in 4 cases. Gross examination of the cases showed a polypoidal lesion in 4 cases, papillary projections from the wall in 2 cases. Focal wall thickening was seen in 2 cases while one case showed diffuse wall thickening. Microscopic examination revealed presence of intracholecystic papillary neoplasm which was associated with invasive adenocarcinoma in 7 out of the nine cases. Histologically, the most common type of ICPN in our study was gastric foveolar type (5 cases) followed by biliary type (3 cases) and intestinal type seen in 1 case. ICPN is a known precursor lesion of gall bladder carcinoma. Our case series is an attempt to add to our knowledge of the clinicopathological features of this entity, particularly in the ethnically distinct and heterogeneous population of northeastern India.

Intracholecystic papillary neoplasm: A case report

INTRODUCTION AND IMPORTANCE

More needs to be understood concerning the natural progression and visual attributes of intracholecystic papillary neoplasm. Its longevity, especially the rate at which it transitions from benign to malignant growths, remains ambiguous. Consequently, it is imperative to elucidate the intrinsic progression of this precancerous lesion in the gallbladder.

CASE PRESENTATION

A 70-year-old North African woman arrived at the emergency department with abdominal pain, anorexia, and weight loss. The patient's physical examination showed favourable results for abdominal pain, nausea, vomiting, and constipation. A CT scan revealed a heterogeneous fundic tissue mass within the gallbladder, which indicated a cholecystectomy due to clinical manifestations and suspicion of a neoplastic disease. The patient underwent a laparoscopic cholecystectomy, and the removed gallbladder was addressed for pathological analysis, revealing an intracholecystic papillary neoplasm.

CLINICAL DISCUSSION

Intracholecystic papillary neoplasm (ICPN) is a rare precancerous tumour affecting middle-aged women aged 38 to 83. It is characterized by raised projections of the lining epithelium in the gallbladder cavity, with a prominent mucinous substance. ICPN can be diagnosed using ultrasound, CT scan, and MRI. Treatment usually involves surgical removal of the gallbladder, known as cholecystectomy, and histological analysis to determine the tumour's stage and grade. Early detection is crucial for preventing the progression of ICPN into invasive carcinoma.

CONCLUSION

Due to the rarity of ICPN, more data are needed to establish more effective diagnostic procedures and screening criteria. The main objective of reporting this case is to increase awareness of this rare and potentially fatal tumour.

Intraductal papillary neoplasms of the bile ducts: a comparative study of a rare disease in Europe and Nagoya, Japan

BACKGROUND

Intraductal papillary neoplasm of the bile ducts (IPNB) is a rare disease in Western countries. The aim of this study was to compare tumor characteristics, management strategies, and outcomes between Western and Eastern patients who underwent surgical resection for IPNB.

METHODS

A multi-institutional retrospective series of patients with IPNB undergoing surgery between January 2010 and December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), and at Nagoya University Hospital, Japan.

RESULTS

A total of 85 patients (51% male; median age 66 years) from 28 E-AHPBA centers were compared to 91 patients (64% male; median age 71 years) from Nagoya. Patients in Europe had more multiple lesions (23% vs 2%, P < .001), less invasive carcinoma (42% vs 85%, P < .001), and more intrahepatic tumors (52% vs 24%, P < .001) than in Nagoya. Patients in Europe experienced less 90-day grade >3 Clavien-Dindo complications (33% vs 68%, P < .001), but higher 90-day mortality rate (7.0% vs 0%, P = .03). R0 resections (81% vs 82%) were similar. Overall survival, excluding 90-day postoperative deaths, was similar in both regions.

DISCUSSION

Despite performing more extensive resections, the low perioperative mortality rate observed in Nagoya was probably influenced by a combination of patient-, tumor-, and surgery-related factors.

Pathological characterization of intracholecystic papillary neoplasm: A recently proposed preinvasive neoplasm of gallbladder

Intracholecystic papillary neoplasm (ICPN) is a recently proposed gallbladder neoplasm. Its prevalence and pathologies remain to be clarified. A total of 38 ICPN cases (28 ICPNs identified among 1904 cholecystectomies (1.5%) and in 100 surgically resected primary gallbladder neoplasms (28%) in Fukui Prefecture Saiseikai Hospital, Japan, and other 10 ICPNs) were examined pathologically and immunohistochemically. They were composed of 21 males and 17 females with a mean age of 75 years old, and presented intraluminal growth of papillary lesions with fine fibrovascular stalks. ICPNs were relatively frequent in the fundus (n = 11) and body (n = 9). Grossly, the conglomerated sessile type (n = 30) was more frequent than the isolated polypoid type (n = 8). All cases were classified as high-grade dysplasia, and they were further divided into 22 cases presenting irregular structures and 16 cases presenting regular structures. The former showed frequent complicated lesions and stromal invasion (54.5%) compared to the latter (12.5%). Twenty-four cases showed predominantly either of four subtypes (11 gastric, 7 intestinal, 4 biliary and 2 oncocytic subtype), while the remaining14 cases showed mixture of more than two subtypes. In conclusion, ICPN presented unique preinvasive neoplasm with characteristic histopathologies. Irregular histologies and complicated lesions of ICPN were related to stromal invasion.

Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone removal by percutaneous transhepatic choledochoscopy: a case report

Background

Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are rare, preinvasive lesions characterized by an intracholecystic papillary growth that may be associated with invasive adenocarcinoma. The natural history of ICPN is unknown. Here, we report a case of ICPN, highlighting its natural course.

Case presentation

A 79-year-old woman presented to the emergency department with perforated cholecystitis. After percutaneous transhepatic gallbladder drainage, due to the presence of surgical risk factors, we opted to perform gallstone removal through percutaneous transhepatic cholangioscopy instead of cholecystectomy. ICPN, which was accidentally detected after the removal of the gallbladder stones, was also endoscopically removed. After 4 years, the patient came back to the hospital with a large gallbladder mass. After cholecystectomy, pathological examination revealed ICPN with invasive adenocarcinoma.

Conclusion

The current case showed endoscopic findings of ICPN and its natural progression, particularly its clinicopathological features and outcomes.

A case of gallbladder adenocarcinoma arising in association with intracystic papillary neoplasm (ICPN) with abundant mucin production

Intracystic papillary neoplasm (ICPN) of the gallbladder is a rare clinicopathological entity with a wide range of malignant potentials. Here, we report a case of mucin-producing gallbladder carcinoma possibly derived from ICPN. A 78-year-old female patient was referred to our hospital for examination of jaundice. Abdominal CT showed dilated biliary trees and a contrast-enhanced large polypoid mass in the gallbladder. Duodenoscopy showed a large amount of mucin extravasating from the ampulla of Vater. Bile cytology showed no evidence of malignancy. Under the diagnosis of mucin-producing gallbladder tumor, we performed laparoscopic cholecystectomy. Macroscopically, there was a large papillary tumor throughout the entire gallbladder mucosa. Pathological examinations showed a gallbladder adenocarcinoma localized to the mucosa in association with ICPN. Immunohistochemical analysis of the tumor revealed positive staining for MUC2 and MUC5AC but negative for MUC1 and MUC6, suggestive of the intestinal type.

CK20 and lymph node involvement predict adverse outcome of malignant intraductal papillary neoplasm of the bile duct

OBJECTIVES

To identify prognostic factors of malignant intraductal papillary neoplasm of the bile duct (m-IPNB).

MATERIALS AND METHODS

We included 38 consecutive cases which underwent surgical resection and diagnosed as IPNB with malignant component from January 2003 to January 2017. Clinicopathological variables were collected to conduct survival analysis and identify prognostic factors.

RESULTS

The median overall survival (OS) of m-IPNB was 76.0 months, with 1-, 3-, and 5-year survival rates of 97.2%, 73.5%, and 59.8%, respectively. The median RFS was 48.0 months with 1-, 3-, and 5-year recurrence-free survival (RFS) rate was 83.2%, 59.8%, and 44.6%, respectively. Univariate analysis showed that elevation of carcinoembryonic antigen CEA, lymph node involvement, resection margin status, degree of periductal invasion, and positive expression of CK20 were associated with both OS and RFS of m-IPNB. After multivariate Cox models analysis, lymph node involvement and positive expression of CK20 were identified as independent prognostic factors for OS, while lymph node involvement and resection margin status were independent prognostic factors for RFS. The median OS of patients with m-IPNB involving lymphatic metastases and positive expression of CK20 was 27.0±8.8 months and 51.0±12.4 months, respectively. The median RFS of cases with lymph node involvement and R1 resection was 10.0±3.3 months and 25.0±6.9 months, respectively. However, there was no significant difference in OS or RFS between cases of pancreaticobiliary and intestinal subtype.

CONCLUSIONS

Lymph node involvement and positive expression of CK20 are independent prognostic factors for shorter OS of m-IPNB, while patients with lymph node involvement and positive resection margin are at higher risk of tumor recurrence.

The Cancer Stem Cell Inhibitor Napabucasin (BBI608) Shows General Cytotoxicity in Biliary Tract Cancer Cells and Reduces Cancer Stem Cell Characteristics

Biliary tract cancer is a devastating disease with limited therapeutic options. The involvement of cancer stem cells in biliary tract cancer is likely. Napabucasin is a previously described cancer stem cell inhibitor that is currently being used in clinical trials. However, data regarding napabucasin and biliary tract cancer are not available yet. We tested the general cytotoxic effect of napabucasin on a comprehensive biliary tract cancer in vitro model, using resazurin assay and Annexin V/7-AAD staining. The effect of napabucasin on functional cancer stem cell characteristics was analyzed via soft agar assay, aldehyde-dehydrogenase-1 assay, measurement of surface CD326 expression, and measurement of clonogenic growth. The evaluation of the effect of napabucasin on cancer stem cell protein and gene expression was performed using Western blot and reverse transcription-PCR-based human cancer stem cell array. Napabucasin showed a concentration- and cell line-dependent cytotoxic effect, and increased the apoptotic and necrotic cell fractions. Treatment with napabucasin significantly reduced the formation of tumor spheres and clonogenic growth, as well as CD326 surface expression. Expression of cancer stem cell markers were reduced following napabucasin treatment on the protein and mRNA levels. Our study provides first data regarding napabucasin as a promising substance for the treatment of biliary tract cancer.

A case report of intracholecystic papillary neoplasm of the gallbladder resembling a submucosal tumor

BACKGROUND

Intracholecystic papillary neoplasm (ICPN) is defined as papillary tumors detected macroscopically in the gallbladder. We report a case of ICPN which exhibited the atypical form like a submucosal tumor.

CASE PRESENTATION

A 70-year-old man was admitted to our hospital because of hepatic disorder. Computed tomography and magnetic resonance imaging showed irregular thickening of the wall within the gallbladder fundus. Because the lesion might have been malignant, we performed laparoscopic cholecystectomy and liver bed resection. Macroscopic findings showed the mucosal surface of the tumor was smooth, and its form was similar to that of a submucosal tumor. Histopathological examination revealed papillary tumors within the mass with low-grade dysplasia; therefore, we diagnosed ICPN.

CONCLUSION

In the present case, ICPN was resembling a submucosal tumor macroscopically because the tumors arose into the Rokitansky-Aschoff sinus and the adenomyomatous hyperplasia was merged with the ICPN. It is necessary to consider the possibility of tumor lesions within adenomyomatous hyperplasia.