Indraneil Mukherjee, Aleksandr Demin, DO, Ian Provancha, Jocelyn Villanueva, Anupma Agarwal. Staten Island
INTRODUCTION: The clinicopathologic characteristics of epithelial neoplasms of the gallbladder is limited, due to its rarity and because of the variability in terminology. The World Health Organization classification of 2010 added Mucinous cystic neoplasms as a separate entity. The Category of lntracystic papillary neoplasm was created to encompass a vast spectrum of lesions, ranging from innocuous cyst lined by benign epithelium without atypia to extensive invasive carcinomas of mucinous type. We present a case of an incidentally found Intra mural Intraductal Papillary Mucinous Neoplasm of the Gallbladder.
CLINICAL DETAILS: A 67-year-old lady with a BMI of 27 presented with postprandial Right Upper Quadrant Pain. Past Medical History of H.Pylori Gastritis which had been eradicated and 3.3 cm stable Liver Hemangioma. She also had a remote 20 Packyears of smoking.
IMAGING: Sonogram for suspected Gallstones, did not show any gallstones. MRI showed a focal form of adenomyomatosis of the gallbladder fundus and small hemangioma and cysts. Hepatobiliary Scintigraphy with HIDA (99mTc-hepatic iminodiacetic acid) and CCK (cholecystokinin)-stimulated cholescintigraphy demonstrated a gallbladder ejection fraction of 8%.
MANAGEMENT: She underwent an uneventful Laparoscopic Cholecystectomy for Biliary Dyskinesia.
PATHOLOGY: Grossly gallbladder measured 9 x 3 x 2 cm, with smooth and glistening serosa. The gallbladder contained thin green bile with no stones. The wall measuring 0.1 cm in thickness and the mucosa was unremarkable. A thin-walled cyst measuring 2.3×1.8×1.2 cm was seen at the fundus. On cut sections, the cyst contained clear fluid and had a firm, white, 0.1 cm thick wall. It was deemed to be adenomyoma with low grade mucinous dysplastic process or “mural IPMN” pattern is at the fundus of the gallbladder away from the uninvolved cystic duct margin. It was deemed safe to assume that this was clinically inconsequential and the patient was not offered any further invasive treatment other than follow up.
CONCLUSION: Adenomyomatous (AM) is seen in <7 % of cholecystectomies. It does not have the association of being neoplastic itself, but rather appears to be a developmental/malformative process, possibly a version of a duplication/diverticulum. Thus, adenomyomatous nodule may be a more accurate name. Mucinous change with papillary units (“mural IPMN” pattern) occurs in 7%. High-grade dysplasia is seen in 3% and invasive carcinoma, often small, arises in 2%. Overall prognosis is good, but depends on degree of dysplasia or invasion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93828
Program Number: P242
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster