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WHO Classification of Tumours
Intraductal papillary neoplasm (IPN) with an associated invasive carcinoma
Gallbladder and extrahepatic biliary tract


Intracystic/intraductal papillary neoplasms (IPNs) of the gallbladder anf extrahepatic bile ducts are classifiable as low, intermediate or high grade on the basis of degree of cellular and nuclear atypia as IPNs arising from intrahepatic bile ducts. When an invasive carcinoma arises in association with an intracystic/intraductal papillary neoplasm, it should be separately reported and staged. Once invasive carcinoma develops, prognosis is related to the stage of the invasive component and other conventional prognostic factors
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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010


When an invasive carcinoma arises in association with an intracystic papillary neoplasm, the lesion usually has high-grade intraepithelial neoplasia, which is characterized by complex papillary structures lined by cuboidal or low columnar biliary-type cells or columnar intestinal-type cells, often containing variable amounts of mucin. The invasive component is usually a tubular adenocarcinoma, although mucinous carcinoma, undifferentiated carcinoma, small cell carcinoma, and large cell neuroendocrine carcinoma have also been described

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Hoang MP, Murakata LA, Katabi N, Henson DE, Albores-Saavedra J (2002)
Invasive papillary carcinomas of the extrahepatic bile ducts: a clinicopathologic and immunohistochemical study of 13 cases.
Mod Pathol 15: 1251-8