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WHO Classification of Tumours
Intracystic (gallbladder) or intraductal (bile ducts) papillary neoplasm with low- or intermediate-grade intraepithelial neoplasia
Gallbladder and extrahepatic biliary tract


Definition

Intraluminal papillary neoplasms of the extrahepatic biliary tree are referred to as “intracystic” in the gallbladder and “intraductal” in the extrahepatic bile ducts.

Intracystic papillary neoplasm of the gallbladder
Similar to intraductal papillary neoplasms described in the extrahepatic and intrahepatic biliary tree, intracystic papillary neoplasms of the gallbladder may occur as pancreatobiliary or intestinal phenotypes, the latter with goblet, Paneth, and/or serotonin-containing cells. Previously, the low-grade lesions were sometimes designated “papillary adenoma” and the high-grade lesions as “noninvasive papillary carcinoma.” These neoplasms often arise in a background of pyloric-gland metaplasia. Intracystic papillary neoplasms of the gallbladder may be associated with invasive adenocarcinoma, which should be separately reported as intracystic papillary neoplasm with an associated invasive carcinoma and staged.

Intraductal papillary neoplasm of the extrahepatic bile ducts
Intraductal papillary neoplasms may dilate the bile ducts, and luminal accumulation of mucin may occur

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Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T, Batra SK, Hollingsworth MA, Imai K, Nimura Y, Yonezawa S (2004)
Pathologic features of mucin-producing bile duct tumors: two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms.
Am J Surg Pathol 28: 327-38




Click to access Pubmed
Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S, Kurumaya H, Katayanagi K, Kawashima A, Masuda S, Niwa H, Mitsui T, Asada Y, Miura S, Ohta T, Nakanuma Y (2006)
Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas.
Hepatology 44: 1333-43



; the latter is much less common in biliary lesions than in pancreatic intraductal papillary mucinous neoplasms (IPMNs). As with pancreatic IPMNs, four phenotypes of epithelium are recognized: pancreatobiliary (the most common in the biliary tree), intestinal, oncocytic, and gastric types (the two latter types are rare)
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Klöppel G, Kosmahl M (2006)
Is the intraductal papillary mucinous neoplasia of the biliary tract a counterpart of pancreatic papillary mucinous neoplasm?
J Hepatol 44: 249-50




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Rouzbahman M, Serra S, Adsay NV, Bejarano PA, Nakanuma Y, Chetty R (2007)
Oncocytic papillary neoplasms of the biliary tract: a clinicopathological, mucin core and Wnt pathway protein analysis of four cases.
Pathology 39: 413-8




Click to access Pubmed
Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T, Batra SK, Hollingsworth MA, Imai K, Nimura Y, Yonezawa S (2004)
Pathologic features of mucin-producing bile duct tumors: two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms.
Am J Surg Pathol 28: 327-38




Click to access Pubmed
Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S, Kurumaya H, Katayanagi K, Kawashima A, Masuda S, Niwa H, Mitsui T, Asada Y, Miura S, Ohta T, Nakanuma Y (2006)
Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas.
Hepatology 44: 1333-43



. The clinicopathological condition previously referred to as “biliary papillomatosis” is characterized by multiple, recurring intraductal papillary neoplasms that may involve extensive areas of the extrahepatic bile ducts and even extend into the gallbladder and intrahepatic ducts
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Abraham SC, Lee JH, Boitnott JK, Argani P, Furth EE, Wu TT (2002)
Microsatellite instability in intraductal papillary neoplasms of the biliary tract.
Mod Pathol 15: 1309-17




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Lee SS, Kim MH, Lee SK, Jang SJ, Song MH, Kim KP, Kim HJ, Seo DW, Song DE, Yu E, Lee SG, Min YI (2004)
Clinicopathologic review of 58 patients with biliary papillomatosis.
Cancer 100: 783-93



. The disease affects males and females equally, most being between the ages of 50 and 70 years. In the Republic of Korea, Taiwan (China) and Japan, about 30% of cases are associated with stones and 25% with flukes
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Lee SS, Kim MH, Lee SK, Jang SJ, Song MH, Kim KP, Kim HJ, Seo DW, Song DE, Yu E, Lee SG, Min YI (2004)
Clinicopathologic review of 58 patients with biliary papillomatosis.
Cancer 100: 783-93



. Invasive carcinoma may occur in association with intraductal papillary neoplasms
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Zen Y, Fujii T, Itatsu K, Nakamura K, Konishi F, Masuda S, Mitsui T, Asada Y, Miura S, Miyayama S, Uehara T, Katsuyama T, Ohta T, Minato H, Nakanuma Y (2006)
Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct.
Mod Pathol 19: 1243-54




Click to access Pubmed
Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S, Kurumaya H, Katayanagi K, Kawashima A, Masuda S, Niwa H, Mitsui T, Asada Y, Miura S, Ohta T, Nakanuma Y (2006)
Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas.
Hepatology 44: 1333-43



and should be separately reported as intraductal papillary neoplasm with an associated invasive carcinoma and staged.

Commentary: Preneoplastic lesions of the digestive system


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