Intracholecystic Papillary-Tubular Neoplasm. Case Report and Review
Oscar Varela Zobra*, Ione Fornaguera Marimon 1, Catalina Uribe1, Víctor Marcilla1, Immaculada Pros1,
María Socias Seco1, Anna Sturlesse1, Joan Robuste 1
*Correspondence to: Dr. Oscar Varela Zobra, Attending surgeon at General Surgery service in Fundación Hospital Sant Joan De Deu de Martorell.
Copyright.
© 2026 Dr. Oscar Varela Zobra, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 July 2026
Published: 01 August 2026
DOI: https://doi.org/10.5281/zenodo.21715178
Abstract
Key Clinical Message.
An 81-year-old male with multiple comorbidities admitted for right upper quadrant pain. Imaging revealed gallbladder enlargement, wall thickening, and lithiasis. After laparoscopic cholecystectomy, pathology identified an intestinal-type intracholecistic papillary neoplasm (ICPN) with low-grade epithelial dysplasia. The patient’s postoperative course was uneventful, with no evidence of hepatobiliary disease on follow-up.
ICPN accounts for about 20% of gallbladder neoplasms and is often discovered incidentally after cholecystectomy for stones. ICPN is an emerging entity requiring multidisciplinary management and long-term follow-up after resection
Key words
Intracholecystic papillary neoplasm, case report, gallblader neoplasm.
Introduction
Intracholecystic papillary-tubular neoplasm (ICPN) is a relatively new entity which includes neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm(1). Is defined as a gallbladder lesion of an intraductal papillary neoplasm of the bile duct(2). The most recent WHO classification (5th edition) recognizes pyloric gland adenoma, biliary intraepithelial neoplasia, mucinous cystic neoplasm, intracholecystic papillary neoplasm (ICPN), and intraductal papillary neoplasm of the bile ducts (IPNB) as benign epithelial neoplasms and precursor lesions of the gallbladder and extrahepatic bile ducts (11).
Usually presents as an incidental finding after a cholecistectomy performed in symptomatic gallbladder stones, or a radiological finding during a workup for abdominal pain.(4) Very rarely, may protrude into the CBD due to an increased intracholecystic pressure and cause jaundice. (14,15)
The gold standard to establish the diagnosis is the pathological examination. ICPN is considered as premalignant, although associated invasive carcinomas may be present in the specimen. Invasive carcinoma arising from intracholecystic papillary-tubular neoplasm have a better prognosis than de novo gallbladder carcinomas.(4)
Case History / Examination
An 81-year-old male patient with a history of arterial hypertension, atrial fibrillation with oral anticoagulation, type 2 diabetes mellitus, dyslipidemia, and chronic obstructive pulmonary disease, who was admitted from the emergency room with right upper quadrant abdominal pain and a positive Murphy's sign.
HE staind of our case. Shows papillary disposition of the gland, with low grade dysplasia and numerous Rokitansky-Aschoff sinuses, without evidence of invasion of adjacent tissue.
Methods
Abdominal ultrasound demonstrated a distended gallbladder with thickened walls, biliary sludge, and lithiasis. Dilated bile duct with a 14 mm common bile duct. MRI Cholangiography: showed a distended gallbladder with lithiasis and perivesicular fluid. Bile duct of 9 mm. Suspicion of distal choledocholithiasis of 6 mm. Pancreas and liver without lesions.
An endoscopic ultrasound was performed and showed cholelithiasis with cholecystitis, bile duct of preserved caliber. Normal morphology of the papilla. Normal-appearing liver. No adenopathies.
During his admission, he had a congestive heart failure episode treated wit diuretics and optimal fluid restriction, and in view of paraclinical improvement, scheduled surgery was decided. Successive follow-ups in consultation showed improvement in the excretion profile.
Conclusions and Results
Written informed consent from the patient was obtained according to journal guidelines. A laparoscopic cholecystectomy with indocyanine green, was performed. Satisfactory postoperative course. Discharged from the hospital the day after the intervention.
Pathology description: Cholecystectomy specimen sent closed, measuring 9 x 3.5 x 3 cm. No stones were present upon sectioning. The mucosa is rough and greenish-orange in color, with multiple polypoid structures measuring between 0.6 and 0.1 cm in an area of 5.5 x 4 cm. The maximum wall thickness is 0.3 cm. No cystic lymph node isolated.
Diagnosis: Intracystic papillary neoplasm of the intestinal type with low-grade epithelial dysplasia.
Lesion size: extension in an area of 5.5 cm in maximum diameter.
Mural invasion: numerous Rokitansky-Aschoff sinuses observed without evidence of invasion of adjacent tissue. No lymphovascular or perineural invasion observed. Circumferential resection margin and the vesicular neck free of lesion.
In subsequent follow-ups, the patient continues a normal postoperative course, with no evidence of hepatobiliary disease.
Discussion
ICPN comprises around 20% of all gallbladder neoplasms. Diagnosis can be performed radiologically, or as an incidental finding during cholecystectomy in a patient with stones. Is found in 0.4% of cholecystectomies. They are more common in female in the sixth and seventh decades in life. Approximately one-third of the cases show invasion.
The most common histological pattern is papillary, followed by papillary-tubular and finally by tubular pattern. (1,2)
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 (3). Is a recent emerging entity, described first in he 2010 World Health Organization as gallbladder lesions of intraductal papillary neoplasms of the bile duct, classified as premalignant lesions of the biliary tract and a counterpart of intraductal papillary mucinous neoplasm of the pancreas (IPMN). Shows various degrees of dysplasia from low- to high-grade and finally to invasive carcinoma, and the histological findings are often mixed. This variation of dysplastic degree demonstrates the adenoma-carcinoma sequence. (6,7,8)
ICPN is classified as four morphological subtypes, namely biliary, gastric, intestinal, and oncocytic. It can be associated with invasive carcinoma. Risk factors are biliary morphology or high-grade dysplasia (5,6).
The accumulation of genetic mutations with tumor progression was suggested in the previous case series of ICPN, and ICPN exhibited slight p53 and MIB-1 staining, reflecting its mutation in a previous case series. Positive staining for β-catenin suggested activation of the Wnt/β-catenin pathway in ICPN [9,10].
About 6% of all gallbladder carcinomas arise in association with ICPN. The 5-year survival rate of non-invasive ICPN after cholecystectomy is around 80% and in the invasive type is 60%. Although the natural history is not yet clear, carcinoma of the biliary tract can develop in patients with ICPN. The carcinomas arising from a ICPN had a far better clinical outcome compared with pancreatobiliary-GB carcinoma (3-yr survival, 27%). This feature of ICPN resembles that of IPMN, which sometimes occurs concomitantly with pancreatic ductal adenocarcinoma. Therefore, long-term surveillance is needed after resection of ICPN as well as IPMN.(2,6,12)
Conclusion
A comprehensive understanding of neoplastic polyps of the gallbladder is still limited. Pathological examination of these lesions is crucial for identifying key features that can influence patient outcomes and survival.
References