Intracholecystic tubular non-mucinous neoplasm (ICTN) of the gallbladder: a clinicopathologically distinct, invasion-resistant entity

Pehlivanoğlu, Burçin; Balcı, Serdar; Baştürk, Olca; Bağcı, Pelin; Seven, İpek Erbarut; Memiş, Bahar; Dursun, Nevra; Saka, Burcu; Ohike, Nobuyuki; Tajiri, Takuma; Roa, Juan Carlos; Sarmiento, Juan M.; Reid, Michelle D.; Adsay, Volkan

doi:10.1007/s00428-020-02877-7

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…In all cases, the atypia automatically qualifies the lesion as high‐grade dysplasia; however, ICTNs do not appear to be associated with invasion. Typically, the background mucosa shows no dysplasia 19 . Similar to pancreatic intraductal tubulopapillary neoplasms, 18 the majority of ICTNs are diffusely positive for MUC6 and lack MUC5AC expression.…”

Section: Precursor Lesionsmentioning

confidence: 99%

“…Most of the information reflects assumptions based on other organs, as well as ‘guilt by association’ (occurrence in association with carcinoma) and epidemiological correlations. The authors have organised international consensus meetings 16,17 and conducted numerous studies on this topic in the past few years, some of which have already been published 4,14,18–21 ; some are still in preparation and have been published in abstract form 16,17,22–34 . These will be reviewed in the following text.…”

Section: Precursor Lesionsmentioning

confidence: 99%

“…In fact, there are rare transitional cases showing some mucinous pyloric‐type glands within the lesion. Nuclear β‐catenin expression is also common and is usually limited to the morules, but in some cases it may even be diffuse 19 …”

Section: Precursor Lesionsmentioning

confidence: 99%

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Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

2021

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Pathological evaluation of gallbladder neoplasia remains a challenge. A significant proportion of cases presents as clinically and grossly inapparent lesions, and grossing protocols are not well established. Among epithelial alterations, pseudo‐pyloric gland metaplasia is ubiquitous and of no apparent consequence, whereas goblet cell metaplasia and a foveolar change in surface cells require closer attention. Low‐grade dysplasia is difficult to objectively define and appears to be clinically inconsequential by itself; however, extra sampling is required to exclude the possibility of accompanying more significant lesions. For high‐grade dysplasia (‘high‐grade BilIN’, also known as ‘carcinoma in situ’), a complete sampling is necessary to rule out invasion. Designating in‐situ or minimally invasive carcinomas limited to muscularis or above as early gallbladder carcinoma (EGBC) helps to alleviate the major geographical differences (West/East) in the criteria for ‘invasiveness’ to assign a case to pTis or pT1. Total sampling is crucial in proper diagnosis of such cases. A subset of invasive GBCs (5–10%) arise from the intracholecystic neoplasm (ICN, ‘adenoma‐carcinoma sequence’) category. Approximately two‐thirds of ICNs have invasive carcinoma. However, this propensity differs by subtype. True ‘pyloric gland adenomas’ (> 1 cm) are uncommon and scarcely associated with invasive carcinoma. A distinct subtype of ICN composed of tubular, non‐mucinous MUC6+ glands [intracholecystic tubular non‐mucinous neoplasm (ICTN)] forms a localised pedunculated polyp. Although it is morphologically complex and high‐grade, it appears to be invasion‐resistant. Some of the invasive carcinoma types in the gallbladder have been better characterised recently with adenosquamous, neuroendocrine, poorly cohesive and mucinous carcinomas often being more advanced and aggressive.

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Section: Precursor Lesionsmentioning

confidence: 99%

Section: Precursor Lesionsmentioning

confidence: 99%

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Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

2021

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“…Recently, a new term, intracholecystic tubular non-mucinous neoplasm (ICTN), was proposed for a type of preinvasive tumor-forming gallbladder neoplasm composed of small, non-mucinous tubules, often with squamoid morules and cholesterolosis in the background, showing diffuse MUC6 expression [ 22 ]. According to the authors, PGAs occur due to the proliferation of tumor cells with cytoplasmic mucin, whereas ICTNs are non-mucinous tumor cells.…”

Section: Pyloric Gland Adenomamentioning

confidence: 99%

Precursor Lesions of Gallbladder Carcinoma: Disease Concept, Pathology, and Genetics

et al. 2022

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Understanding the pathogenesis and carcinogenesis of gallbladder adenocarcinoma is important. The fifth edition of the World Health Organization’s tumor classification of the digestive system indicates three types of preinvasive neoplasm of the gallbladder: pyloric gland adenoma (PGA), biliary intraepithelial neoplasia (BilIN), and intracholecystic papillary neoplasm (ICPN). New terminologies have also been introduced, such as intracholecystic papillary-tubular neoplasm, gastric pyloric, simple mucinous type, and intracholecystic tubular non-mucinous neoplasm (ICTN). Pancreatobiliary maljunction (PBM) poses a markedly high risk for bile duct carcinoma, which was analyzed and investigated mainly by Asian researchers in the past; however, recent studies have clarified a similar significance of biliary carcinogenesis in Western countries as well. In this study, we reviewed and summarized information on three gallbladder neoplastic precursors, PGA, BilIN, and ICPN, and gallbladder lesions in patients with PBM.

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“…7 Intracholecystic papillary neoplasms are dividable into solitary polypoid type and conglomerated type. 4 The latter is a sessile lesion composed of conglomerated polypoid and/or large granular neoplasm and also shows high-grade intraepithelial neoplasm or dysplasia in the surrounding mucosa 5 and also frequent intraepithelial involvement of the non-neoplastic glands and cysts in the gallbladder wall by neoplastic epithelia of ICPN. 4 The former is a single polypoid lesion.…”

Section: Definition Of Icpn and Pica And Case Selectionmentioning

confidence: 99%

Polypoid invasive carcinoma of the gallbladder‐Another challenging polypoid neoplasm‐

Nakanuma

Sugino

Nomura

et al. 2021

J Hepato Biliary Pancreat

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Background Invasive gallbladder carcinoma generally presents as nodular‐sclerosing growth. Recently, “polypoid invasive carcinoma (PICA)” showing grossly visible polypoid neoplasm and histologically invasive carcinoma with no adenomatous components was proposed as a neoplastic polyp of the gallbladder. Methods We herein report five cases of PICA collected from 49 cases of invasive gallbladder carcinoma in comparison with another polypoid preinvasive neoplasm of gallbladder, intracholecystic papillary neoplasm (ICPN). Results Polypoid invasive carcinomas were composed of four males and one female with an average age of 74 years. Polypoid lesions were sessile (height ranging from 6 to 10 mm and the largest diameter ranging from 12 to 40 mm), and histologically, polypoid neoplasms presented papillary configuration containing tubular and cribriform components with thin inflammatory, fibrotic stroma. Polypoid carcinoma invaded directly and continuously into the gallbladder wall with destruction of the muscle layer. These patterns of PICA were different from ICPN, showing papillary patterns containing tubular components with fine fibrovascular stalks and with occasional focal stromal invasion but with preserved muscle layer. Post‐operative outcome was not favorable in PICA but was favorable in ICPN. Conclusions Polypoid invasive carcinoma shared several pathological features with ICPN, such as intraluminal polypoid pattern with papillary configurations, but PICAs were invasive adenocarcinoma with destruction of muscle layer while ICPNs were preinvasive neoplasm with occasional focal stromal invasion, thus both should be differentiated from each other.

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Intracholecystic tubular non-mucinous neoplasm (ICTN) of the gallbladder: a clinicopathologically distinct, invasion-resistant entity

Cited by 17 publications

References 20 publications

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

Precursor Lesions of Gallbladder Carcinoma: Disease Concept, Pathology, and Genetics

Polypoid invasive carcinoma of the gallbladder‐Another challenging polypoid neoplasm‐

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