Intracholecystic tubular non-mucinous neoplasm (ICTN) of the gallbladder: A clinicopathologically distinct, invasion-resistant entity Journal Article


Authors: Pehlivanoglu, B.; Balci, S.; Basturk, O.; Bagci, P.; Seven, I. E.; Memis, B.; Dursun, N.; Jang, K. T.; Saka, B.; Ohike, N.; Tajiri, T.; Roa, J. C.; Sarmiento, J. M.; Reid, M. D.; Adsay, V.
Article Title: Intracholecystic tubular non-mucinous neoplasm (ICTN) of the gallbladder: A clinicopathologically distinct, invasion-resistant entity
Abstract: Preinvasive tumor-forming gallbladder neoplasms that are composed of small, non-mucinous tubules with complex architecture remain a poorly characterized group. Here, we evaluated the clinicopathological characteristics of this entity. Twenty-eight examples were analyzed. Tumors were invariably pedunculated polyps with thin stalks, often presented as loosely attached intraluminal nodules, with cauliflower architecture (akin to cholesterol polyps) comprised of compact, back-to-back acinar-like, small tubular units with minimal/no cytoplasm showing variable complexity, creating a picture distinct from the other tubular type dysplasia in the gallbladder. Their limited stroma showed distinctive amorphous amyloid-like hyalinization (39%). While some had round nuclei with single prominent nucleoli, others exhibited slightly more elongated nuclei with washed out chromatin reminiscent of papillary thyroid carcinoma. Squamoid/meningothelial-like morules (71%) and subtle neuroendocrine cell clusters (39%) were frequent. The level of cytoarchitectural atypia qualified as high-grade dysplasia (HGD) in all cases, but none were invasive. The background mucosa showed no dysplasia, but cholesterolosis. The majority (n = 8/12) showed diffuse MUC6 expression and lacked MUC5AC expression. Based on these observations, 635 gallbladder carcinomas were re-analyzed for residual/adjacent lesions with entity-defining characteristics disclosed here, and none could be identified. Preinvasive tubular non-mucinous neoplasm of the gallbladder, which we propose to classify as intracholecystic tubular non-mucinous neoplasm, is a clinicopathologically discrete entity, which tends to occur in uninjured gallbladders and in association with cholesterol polyps. By being tubular, non-mucinous and MUC6-positive, it is akin to intraductal tubulopapillary neoplasms of pancreatobiliary tract, but it is also different in many other aspects. Although their cytoarchitectural complexity warrants an HGD/carcinoma classification, they do not show invasion and their distinct characteristics warrant their separate classification. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords: immunohistochemistry; adult; human tissue; protein expression; aged; major clinical study; clinical feature; histopathology; microscopy; follow up; adenoma; stroma; cholesterol; mucin 1; incidental finding; cholecystectomy; gallbladder carcinoma; gallbladder cancer; thyroid papillary carcinoma; dysplasia; transcription factor cdx2; mucin 5ac; mucin 2; pyloric; mucin 6; neurosecretory cell; gallbladder; hyaline degeneration; preinvasive neoplasm; human; male; female; priority journal; article; common bile duct stone; gallbladder polyp; tubular papillary; intracholecystic tubular non mucinous neoplasm
Journal Title: Virchows Archiv
Volume: 478
Issue: 3
ISSN: 0945-6317
Publisher: Springer  
Date Published: 2021-03-01
Start Page: 435
End Page: 447
Language: English
DOI: 10.1007/s00428-020-02877-7
PUBMED: 32691142
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 April 2021 -- Source: Scopus
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MSK Authors
  1. Olca Basturk
    252 Basturk