Abstract
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.
Highlights
Gallbladder cancer is the 22nd most prevalent and 17th most deadly cancer worldwide [1,2,3]
The advent of laparoscopic cholecystectomy (LC) for gallbladder lesions has been associated with an increased number of incidental gallbladder carcinomas, and some patients with incidental carcinomas may experience trocar metastasis and peritoneal spreading caused by bile spillage during LC, which again emphasizes the importance of establishing preoperative biomarkers for gallbladder carcinoma [9]
One possible reason may be that pyloric gland adenoma (PGA) is relatively well-characterized as a neoplastic precursor gallbladder lesion and is more innocuous in behavior compared to other tumors categorized under intracholecystic papillary neoplasm (ICPN) [15], it is treated as an independent entity
Summary
Gallbladder cancer is the 22nd most prevalent and 17th most deadly cancer worldwide [1,2,3]. According to the American Joint Committee on Cancer, survival of gallbladder adenocarcinoma is based on the staging of the disease, with an 80% five-year survival rate in patients with stage 0 carcinoma in situ lesions and 2% in those with stage 4b disease [7,8], which emphasizes the importance of detection at the early or precursor stage. Compared to other organs, such as colon, uterus, prostate, and pancreas, knowledge of the precursor lesions of gallbladder carcinoma is limited, and their clinicopathologic features are insufficiently characterized. This is partly due to the rarity of these lesions, controversies about the criteria for diagnosis, and the use of several ununified terms when referring to the lesions [10,11,12]. We review and summarize the present knowledge on the concept, pathology, and molecular features of the three types of neoplastic precursors and gallbladder lesions in pancreatobiliary maljunction of the gallbladder
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