Intracholecystic papillary neoplasms, previously known as intracystic/intraductal papillary tubular neoplasms 2, are rare, pre-invasive neoplasms of the gallbladder.
On imaging, these lesions resemble adenomas of the gallbladder or have features suspicious for gallbladder carcinoma, which usually lead to cholecystectomy and diagnosis. Given those non-specific imaging features, they should be reported and managed as per the gallbladder polyp guidelines.
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Terminology
As the distinction of intracholecystic papillary neoplasms from gallbladder adenomas is not entirely clear, with important overlap between both entities, some authors have proposed that both conditions should be grouped under the same terminology 1. When an invasive component is present, the lesion is called intracholecystic papillary neoplasm with an associated invasive carcinoma 2.
Epidemiology
Intracholecystic papillary neoplasms are rare, corresponding to ~0.5% of all gallbladder neoplasms ref. They are most frequent in women in their 6th decade of life 2.
Associations
no association with gallstones 2
Clinical presentation
Most of the cases are asymptomatic, although right upper quadrant abdominal pain has been reported 2.
Pathology
Intracholecystic papillary neoplasms are tumors analogous to intraductal papillary neoplasms of the bile ducts (IPNB), intraductal papillary mucinous neoplasms (IPMN) of the pancreas and pancreatic intraductal tubulopapillary neoplasms (ITPN) 2.
Adsay et al. have proposed that all gallbladder preinvasive adenomas over 1 cm should be grouped under the term ICPN 1.
Microscopic appearance
papillary or tubulopapillary patterns
high-grade dysplasia is frequent (up to 75% to 100%) 2
an invasive component is also prevalent (up to ~72%) 2
Immunophenotype
MUC1 expression is frequent 2
Radiographic features
Although there are no large series in the literature to support an overall imaging pattern of these lesions, it is known that they present similar to large polyps, particularly adenomas, or to intraluminal masses suspicious for gallbladder carcinoma.
Treatment and prognosis
Most cases, if not all, will be confirmed after surgery, as intracholecystic papillary neoplasms will be managed by the gallbladder polyps guidelines or based on the suspicion of adenocarcinoma of the gallbladder 2.
Intracholecystic papillary neoplasm without an invasive component has a 5-year survival of ~80% and with an invasive component a 5-year survival rate of 60% 2. Intracholecystic papillary neoplasm with an invasive component has a better prognosis compared to conventional adenocarcinoma of the gallbladder 1.
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