Medhi Pranita, Dowerah Swagata, Borgohain Dhrubajyoti, Singh Mridul
Department of Pathology, Assam Medical College and Hospital: Assam Medical College, Dibrugarh, India.
Department of Pathology, Lakhimpur Medical College, Lakhimpur, India.
Indian J Surg Oncol. 2025 Apr;16(2):472-477. doi: 10.1007/s13193-023-01759-z. Epub 2023 May 30.
Intracholecystic papillary neoplasm (ICPN) is defined as a grossly visible, mass-forming, non-invasive epithelial neoplasm arising in the mucosa and projecting into the lumen of the gallbladder. Since the northeastern part of India has a high incidence of gall bladder cancer, ICPN being a precursor lesion is important to be diagnosed on biopsies. Nine cases with Intracholecystic papillary neoplasm of the gall bladder were studied. The clinicoradiological findings of these patients, gross and microscopic findings of H&E-stained sections were recorded and immunohistochemistry was done for Ki 67. The median age of diagnosis was 60 years with a male-to-female ratio 1:3.5. The most common presenting symptom was pain abdomen, other symptoms included vomiting, weight loss, and jaundice. Associated gall stones were seen in 6 of the cases. Radiological investigations revealed gall stones in 6 cases, intraluminal mass lesion/polyp was reported in 4 cases. Gross examination of the cases showed a polypoidal lesion in 4 cases, papillary projections from the wall in 2 cases. Focal wall thickening was seen in 2 cases while one case showed diffuse wall thickening. Microscopic examination revealed presence of intracholecystic papillary neoplasm which was associated with invasive adenocarcinoma in 7 out of the nine cases. Histologically, the most common type of ICPN in our study was gastric foveolar type (5 cases) followed by biliary type (3 cases) and intestinal type seen in 1 case. ICPN is a known precursor lesion of gall bladder carcinoma. Our case series is an attempt to add to our knowledge of the clinicopathological features of this entity, particularly in the ethnically distinct and heterogeneous population of northeastern India.
胆囊内乳头状瘤（ICPN）被定义为一种肉眼可见、形成肿块的非侵袭性上皮性肿瘤，起源于胆囊黏膜并向胆囊腔内突出。由于印度东北部胆囊癌发病率较高，ICPN作为一种癌前病变，在活检时进行诊断很重要。对9例胆囊内乳头状瘤患者进行了研究。记录了这些患者的临床放射学表现、苏木精-伊红（H&E）染色切片的大体和显微镜检查结果，并对Ki 67进行了免疫组织化学检测。诊断时的中位年龄为60岁，男女比例为1:3.5。最常见的症状是腹痛，其他症状包括呕吐、体重减轻和黄疸。6例患者伴有胆结石。放射学检查显示6例有胆结石，4例报告有腔内肿块病变/息肉。病例的大体检查显示4例为息肉样病变，2例为从胆囊壁突出的乳头状突起。2例可见局灶性胆囊壁增厚，1例显示弥漫性胆囊壁增厚。显微镜检查显示9例中有7例存在胆囊内乳头状瘤并伴有浸润性腺癌。组织学上，本研究中最常见的ICPN类型是胃小凹型（5例），其次是胆管型（3例），肠型1例。ICPN是已知的胆囊癌前病变。我们的病例系列旨在增加我们对该实体临床病理特征的认识，特别是在印度东北部种族不同且异质的人群中。
