A case report of intracholecystic papillary neoplasm presenting as gallbladder polyp

James Thiek; Lachit Kalita; Kiran Kamalasanan

doi:10.4103/ijmh.IJMH_70_22

CASE REPORT

Year : 2023 | Volume : 28 | Issue : 2 | Page : 193-195

A case report of intracholecystic papillary neoplasm presenting as gallbladder polyp

James Thiek, Lachit Kalita, Kiran Kamalasanan
Department of Surgical Oncology, Assam Cancer Care Foundation (ACCF), Guwahati, Assam, India

Date of Submission	05-Nov-2022
Date of Decision	24-Nov-2022
Date of Acceptance	06-Feb-2023
Date of Web Publication	21-Mar-2023

Correspondence Address:
James Thiek
Department of Surgical Oncology, Assam Cancer Care Foundation (ACCF), C/O – Suma Thiek, Irrigation Colony Rongkimi, Diphu, Karbi Anglong, Assam
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.IJMH_70_22

Abstract

Intracholecystic papillary neoplasm was a newly proposed term in the 2019 World Health Organization classification of tumors of the digestive system, as a preinvasive neoplasm of the gallbladder. We report a case of intra-cholecystic papillary neoplasm, biliary type with high-grade dysplasia presenting as a polypoidal mass in the fundus of the gallbladder, in a 47-year-old man with a history of periodic abdominal pain and dyspepsia of 6-month duration. As the term for the pathological classification in itself is new, we wish to report this case for record storing purposes that may be imperative if any further study on the said topic is planned in the future.

Keywords: Cholecystectomy, gallbladder polyp, gallbladder, intracholecystic papillary neoplasm

How to cite this article:
Thiek J, Kalita L, Kamalasanan K. A case report of intracholecystic papillary neoplasm presenting as gallbladder polyp. Int J Med Health Dev 2023;28:193-5

How to cite this URL:
Thiek J, Kalita L, Kamalasanan K. A case report of intracholecystic papillary neoplasm presenting as gallbladder polyp. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:193-5. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/193/372158

Introduction

Intracholecystic papillary neoplasm (ICPN) was a newly proposed term in the 2019 World Health Organization (WHO) classification of tumors of the digestive system, as a preinvasive neoplasm of the gallbladder.^[1] In a western series, 24% of cholecystectomies were reported to have ICPN and approximately 6% of carcinoma of the gallbladder were found to have arisen in association with ICPN.^[2] Intraductal papillary neoplasm of the bile duct (IPNB) is characterized predominantly by intraductal papillary growth anywhere along the biliary tree which is a preinvasive neoplastic lesion. ICPN is a type of IPNB occurring in the gallbladder.^[3]

Case Summary

We present a case of a 47-year-old gentleman who presented with a history of periodic pain in the abdomen and dyspepsia for 6 months. He was worked up for the above symptoms with an ultrasonography of the abdomen, which showed a large polypoidal lesion of size 2.7 cm × 2.2 cm in the fundus of the gallbladder with mild vascularity noted in the lesion. The patient was further worked up with contrast-enhanced computed tomography (CECT) thorax, abdomen, and pelvis, which showed a polypoidal lesion with internal vascularity measuring 19 mm × 33 mm arising from gallbladder fundus with maintained GB-Hepatic interface. All routine blood parameters including the liver function test were normal. CA 19-9 was 5 U/mL.

The patient was planned for cholecystectomy-frozen section and to proceed to radical cholecystectomy if the frozen section comes positive for malignancy. Pre-anesthetic clearance was taken and open cholecystectomy was performed on April 1, 2022, and the sample was sent for frozen section along with a cut margin from a cystic duct. Report of frozen section showed ICPN with low-grade dysplasia with cystic duct margin free of tumor, so the abdomen was closed. Postoperative period was uneventful and the patient was discharged on postoperative day 3.

The patient came for follow-up 10 days later as advised by our side and had no complications. Stiches were removed and the patient was asked to come for a review with the final histopathological report. Four days later, the patient came with the final histopathological report which showed tumor of 1.5 cm size in greatest dimension not invading lamina propria or muscularispropria with high-grade dysplasia seen in about 70% of the tumor, these pathological findings were consistent with ICPN, biliary type with high-grade dysplasia. The patient was advised to come every 6 months for the first 2 years for follow-up. [Figure 1] shows microscopic picture of Papillary growth pattern seen in intracholecystic papillary neoplasm from the final HPE of the cholecystectomy specimen.

Figure 1: Papillary growth pattern seen in intracholecystic papillary neoplasm

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Discussion

Initially, intracholecystic papillary neoplasm of the gallbladder was classified under IPNB in the 2010 WHO classification as premalignant lesions of the biliary system in the same category as adenoma, biliary intraepithelial neoplasia, and mucinous cystic neoplasm.^[4] IPNB usually presents as biliary tumors with an exophytic papillary mass which is detected macroscopically within the bile duct lumen, with characteristic intraluminal growth.^[5] IPMN can be divided into four histological subtypes; biliary type, gastric type, intestinal type, and oncocytic type according to IPMN.^[6],[7] Adsay et al.’s^[2] study on the biliary subtype reported 68% of those represented cancer in situ and 69% included infiltrating cancer. ICPN can present with various grades of dysplasia ranging from low- to high-grade and finally to invasive carcinoma, and the histological findings are often mixed.^[6] The case reported in this study is similar to Adsay et al.’s^[2] study and Natov et al.’s^[6] study which presented with histological features of not invading lamina propria or muscularispropria (carcinoma in situ) with high-grade dysplasia.

Conclusions

Herewith we report a case of ICPN, biliary type with high-grade dysplasia presenting as a polypoidal mass in the fundus of the gallbladder. As the term for the pathological classification in itself is new we wish to report the case for record storing purposes which may be imperative if any further study on the said topic is planned in the future.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.

References

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2.	Adsay V, Jang KT, Roa JC, Dursun N, Ohike N, Bagci P, et al. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): Clinicopathologic and immunohistochemical analysis of 123 cases. Am J SurgPathol 2012;36:1279-301.
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