Mural Intracholecystic Neoplasms Arising in Adenomyomatous Nodules of the Gallbladder
Year: 2020
Type: article
Study design: Observational Study
Abstract: Intracholecystic neoplasms (ICNs) (pyloric gland adenomas and intracholecystic papillary neoplasms, collectively also called intracholecystic papillary/tubular neoplasms) form multifocal, extensive proliferations on the gallbladder mucosa and have a high propensity for invasion (>50%). In this study, 19 examples of a poorly characterized phenomenon, mural papillary mucinous lesions that arise in adenomyomatous nodules and form localized ICNs, were analyzed. Two of these were identified in 1750 consecutive cholecystectomies reviewed specifically for this purpose, placing its incidence at 0.1%. Median age was 68 years. Unlike other gallbladder lesions, these were slightly more common in men (female/male=0.8), and 55% had documented cholelithiasis. All were characterized by a compact multilocular, demarcated, cystic lesion with papillary proliferations and mucinous epithelial lining. The lesions' architecture, distribution, location, and typical size were suggestive of evolution from an underlying adenomyomatous nodule. All had gastric/endocervical-like mucinous epithelium, but 5 also had a focal intestinal-like epithelium. Cytologic atypia was graded as 1 to 3 and defined as 1A: mucinous, without cytoarchitectural atypia (n=3), 1B: mild (n=7), 2: moderate (n=2), and 3: severe atypia (n=7, 3 of which also had invasive carcinoma, 16%). Background gallbladder mucosal involvement was absent in all but 2 cases, both of which had multifocal papillary mucosal nodules. In conclusion, these cases highlight a distinct clinicopathologic entity, that is, mural ICNs arising in adenomyomatous nodules, which, by essentially sparing the "main" mucosa, not displaying "field-effect/defect" phenomenon, and only rarely (16%) showing carcinomatous transformation, are analogous to pancreatic branch duct intraductal papillary mucinous neoplasms.
Authors: Daniel J. Rowan, Burcin Pehlivanoglu, Bahar Memis, Pelin Bagci, Ipek Erbarut, Nevra Dursun, Kee-Taek Jang, Juan Sarmiento, Francisco Mucientes, Jeanette D. Cheng, Juan C. Roa, Juan C. Araya, Enrique Bellolio, Hector Losada, Jin-Young Jang, Jill Koshiol, Michelle D. Reid, Olca Basturk, Volkan Adsay
Institutions: Mayo Clinic, Medical College of Wisconsin, Adıyaman University, Marmara University, İstanbul Eğitim ve Araştırma Hastanesi, Sağlık Bilimleri Üniversitesi, Samsung Medical Center, Sungkyunkwan University, Emory University, University of Concepción, Piedmont Atlanta Hospital, Pontificia Universidad Católica de Chile, Hospital Doctor Hernán Henríquez Aravena, Universidad de La Frontera, Seoul National University, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Memorial Sloan Kettering Cancer Center, Koç University, Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3092924030