Intracholecystic Papillary-tubular Neoplasm after Cholecystectomy: What Should We Do?

Abstract

Purpose: Gallbladder cancer (GBC) is the most common cancer of the biliary tract and 60-70% are discovered incidentally by the pathologist following cholecystectomy. Less than 0.5% are intracholecystic papillary-tubular neoplasms (ICPN), a relative indolent neoplasia when compared to pancreatobiliary-type gallbladder carcinomas. Since literature evidence is limited, the aim of this work is to present an ICPN case and its surgical management. Methods: A 64-year-old women with ulcerative colitis, which is associated with primary sclerosing cholangitis and cholangiocarcinoma, is scheduled a laparoscopic cholecystectomy due to adenomyomatosis. Anatomopathological exam showed a papillary neoplasia with microfocus of invasive carcinoma, without cystic lymph node in the piece (pT1bpNx) (Figure 1). According to guidelines recommendations and tumor committee decision, extension study is performed and unresectable disease is ruled out. A radical surgery (4b/5 normal liver margin) and regional lymphadenectomy is indicated. Discussion: In ICPN, high-grade dysplasia, cell type (biliary or foveolar) and papilla formation are factors associated with invasion. Bibliography shows 90% of 3-year survival for cases without invasion, meanwhile, for cases with invasion, it decreases to a 60%. Hence, an aggressive approach is necessary. Nevertheless, ICPN with invasion had a far better clinical outcome compared with pancreatobiliary-type GBC (27% 3-year survival). Conclusions: ICPN is a rare neoplasm of the gallbladder with a relative better prognosis than gallbladder carcinomas, even when invasive carcinoma is found. It should be kept in mind that when invasive carcinoma is identified, it should be staged, and if the disease is resectable, a radical surgery is mandatory.