Intra-cholecystic Tubulopapillary Neoplasm: Is Simple Cholecystectomy Enough?

Intracholecystic tubulopapillary neoplasm (ICPN) is a noninvasive, intraepithelial tumor presenting as a polypoid papillary mass arising from the gallbladder. Approximately 6.4% of all gallbladder neoplasms are associated with ICPNs. A young male presented with pain in the right hypochondrium and epigastrium. An abdominal ultrasound showed a 2.3 x 1.6 cm mass lesion in the gallbladder. Computed tomography (CT) of the abdomen showed an irregular polypoidal intraluminal soft tissue density of 21 x 17 mm in the fundus of the gallbladder. Endoscopic ultrasound (EUS) evaluation was suggestive of a gallbladder mass. On suspicion of carcinoma of the gallbladder, the patient underwent radical cholecystectomy with a 2 cm liver wedge with standard hepatoduodenal ligament, periportal, and retropancreatic lymphadenectomy with uneventful recovery. Postoperative histopathology revealed an ICPN with predominant intestinal morphology and low-grade dysplasia. All 16 lymph nodes were negative for malignancy. Dysplasia was present in the neck region but not in the cystic duct margin. ICPN is a rare entity to be recognized preoperatively. It is considered the counterpart of intraductal papillary mucinous neoplasm in the pancreatic cancer spectrum. Invasive carcinoma is present in almost half of the cases. It has a propensity for rapid conversion to carcinoma of the gallbladder. Preoperatively, if suspected, it should be treated with radical cholecystectomy for the potential of a cure for the invasive component as well as for staging purposes.