Abstract
Neoplastic polypoid mucosal lesions of the gallbladder are increasingly being reported in cholecystectomy specimens. However, due to the absence of unified terminology and reporting criteria, the body of scientific evidence on their classification, prognosis, and management is scarce and sometimes controversial. While they have different histomorphologic features (gastric foveolar, gastric pyloric gland, biliary, and intestinal), a significant immunohistochemical overlap exists which highlights their mixed cell lineage with a dominant cell type in each, establishing the subcategory. Because of many shared attributes, intracholecystic papillary-tubular neoplasm (ICPN) has been introduced as an umbrella terminology. ICPNs of the pyloric subtype are lesions larger than 1 cm, as most of the smaller ones are clinically insignificant and represent polypoid hyperplasia rather than a true neoplasm. In this review, we will focus on the pyloric gland adenomas as the most frequent histologic subtype of ICPNs.
Highlights
Neoplastic polyps of the gallbladder are commonly asymptomatic [1]
Due to lack of unified terminology and reporting criteria, the body of scientific evidence regarding their classification and management is scarce and even sometimes controversial [3]. e plethora of terminology used in scientific literature to describe these lesions includes “pyloric gland adenoma,” “tubulopapillary adenoma,” and “biliary adenoma” [3]
Adsay et al are the first group of investigators who proposed the unified terminology of intracholecystic papillary-tubular neoplasms (ICPNs) to describe neoplastic polyps of the gallbladder [3]. ey used the size of over 1 cm as an inclusion criterion as this size has been used in other lesions of the pancreatobiliary system like intraductal papillary mucinous neoplasms (IPMN)
Summary
Neoplastic polyps of the gallbladder are commonly asymptomatic [1]. advances in radiologic modalities and their growing use for various clinical indications have increased the number of gallbladder polyps being diagnosed and reported [2]. E plethora of terminology used in scientific literature to describe these lesions includes “pyloric gland adenoma,” “tubulopapillary adenoma,” and “biliary adenoma” [3] Even though this diverse group of lesions shares histological and immunohistochemical characteristics, they are distinct entities with different cellular lineages and a spectrum of dysplasia which makes their prognosis different. These lesions are classified as the gastric pyloric gland, gastric foveolar, intestinal, and biliary [4], with the pyloric subtype being the most common lesion (82%) [4]. Adsay et al are the first group of investigators who proposed the unified terminology of intracholecystic papillary-tubular neoplasms (ICPNs) to describe neoplastic polyps of the gallbladder [3]. Pyloric gland subtype, the most frequently encountered in the clinical practice, is discussed in detail [3]
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