Clinicopathological Study of Intracholecystic Papillary-Tubular Neoplasms (ICPNs) of the Gallbladder

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  • ISOZAKI Masayuki
    Department of Pathology Clinico-diagnostic Pathology, Showa University School of Medicine
  • OHIKE Nobuyuki
    Department of Pathology Clinico-diagnostic Pathology, Showa University School of Medicine
  • TAJIRI Takuma
    Department of Pathology, Showa University Fujigaoka Hospital
  • MITSUYA Toshiyuki
    Department of Pathology, Showa University Fujigaoka Hospital
  • TAKIMOTO Masafumi
    Department of Pathology Clinico-diagnostic Pathology, Showa University School of Medicine

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Intracholecystic papillary-tubular neoplasm (ICPN) has recently been proposed as a new disease concept in the classification of gallbladder tumors. ICPN is defined as a papillary or polypoid glandular neoplasm forming a localized, non-invasive mass (≥ 1cm) in the gallbladder. We analyzed the clinicopathological characteristics of ICPN. Resected gallbladder cancer specimens from 57 patients were classified as ICPN or non-ICPN and clinicopathological characteristics were compared. ICPN cell characteristics were also analyzed using immunostaining and genetic analysis. Twenty-three cases were classified as ICPN and 34 as non-ICPN. In the ICPN and non-ICPN groups, mean ages were 69 and 74 years, male:female ratios were 14:9 and 15:19, mean tumor diameters were 2.8 and 2.6cm, invasion depths were Tis+T1/T2+T3 in 14/9 cases and 13/21 cases, lymph node metastases were present in 6% and 43%, distant metastases in 0% and 6% and 3-year survival rates were 91% and 52%, respectively. Significant intergroup differences were seen in lymph node metastases and the 3-year survival rate. ICPN cell lineage was biliary-type in 13 cases, gastric-type in 8 and intestinal-type in 2. This proportion differs from that of pancreatic intraductal papillary mucinous neoplasm (IPMN), in which gastric- and intestinal-type are more common. KRAS gene mutations were only seen in 1 of 13 ICPN cases. ICPN is frequently seen in gallbladder cancer, showing similar pathology to pancreatic IPMN, which is considered to have a relatively good prognosis among pancreatic cancers. However, ICPN cell characteristics are not necessarily identical to those of pancreatic IPMN.

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