Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, 411-8777, Japan; Department of Diagnostic Pathology, Fukui Prefecture Saiseikai Hospital, Fukui, 920-8640, Japan.
Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, 411-8777, Japan.
Hum Pathol. 2021 Oct;116:22-30. doi: 10.1016/j.humpath.2021.06.007. Epub 2021 Jul 12.
Biliary intraepithelial neoplasm (BilIN) is characterized by a microscopically identifiable preinvasive neoplasm of the biliary tract. In this study, the high-grade BilIN of gallbladder was examined pathologically and compared with the intracholecystic papillary neoplasm (ICPN) of gallbladder. Sixteen high-grade BilINs (height <0.5 cm) collected from 2297 cholecystectomies (0.7%) and another three cases (19 cases total) were examined and compared with 34 cases of ICPN (greatest diameter ≥1 cm and height ≥0.5 cm). High-grade BilINs were incidentally found in 11 cholecystectomies, and the remaining eight were cholecystectomized in cases with a preoperative diagnosis of carcinoma. The largest diameter ranged from 0.5 to 6 cm. While 13 cases were recognized grossly as clustered granular and rough mucosa, the remaining were almost unrecognizable. Histologically, the high-grade BilINs showed intraepithelial neoplastic growth. Furthermore, they frequently showed intraepithelial replacement growth to non-neoplastic glands and cystic lesions in the gallbladder. The lesions presented with flat, wave or fold-like patterns, including tubular components. Short papillary components were also found in 13 cases. Gastric and biliary subtypes were frequent. Several foci of stromal invasion were found in the short papillary components in three cases. The lower polypoid or granular parts of conglomerated ICPNs showed intraepithelial neoplastic lesions sharing many features with high-grade BilINs with short papillary components. In conclusion, high-grade BilINs showed intraepithelial growth of neoplastic epithelia involving the mucosa. A morphologic continuum was noted between high-grade BilINs with short papillary components and conglomerated ICPNs, suggesting that conglomerated ICPNs may arise from high-grade BilINs with short papillary components.
胆管上皮内瘤变（BilIN）的特征是胆管的显微镜下可识别的前浸润性肿瘤。在这项研究中，对胆囊高级别 BilIN 进行了病理学检查，并与胆囊内乳头状肿瘤（ICPN）进行了比较。从 2297 例胆囊切除术（0.7%）中收集了 16 例高级别 BilIN（高度<0.5cm），并检查了另外 3 例（共 19 例），并与 34 例 ICPN（最大直径≥1cm 和高度≥0.5cm）进行了比较。高级别 BilIN 在 11 例胆囊切除术中偶然发现，其余 8 例在术前诊断为癌的情况下行胆囊切除术。最大直径范围从 0.5 到 6cm。13 例肉眼上被识别为簇状颗粒状和粗糙的黏膜，其余的几乎无法识别。组织学上，高级别 BilIN 表现为上皮内肿瘤性生长。此外，它们经常表现为上皮内替代生长到胆囊的非肿瘤性腺体和囊性病变。病变呈扁平、波浪或褶皱样模式，包括管状成分。在 13 例中还发现了短的乳头状成分。胃型和胆型较为常见。在 3 例中，短乳头状成分的几个焦点中发现了间质浸润。聚集性 ICPN 的低等息肉状或颗粒状部分表现出与具有短乳头状成分的高级别 BilIN 具有许多相似特征的上皮内肿瘤性病变。总之，高级别 BilIN 表现为涉及黏膜的肿瘤性上皮的上皮内生长。在短乳头状成分的高级别 BilIN 和聚集性 ICPN 之间存在形态学连续性，提示聚集性 ICPN 可能源自具有短乳头状成分的高级别 BilIN。
