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. 2018 Sep 27;4(1):124.
doi: 10.1186/s40792-018-0524-2.

A case report of intracholecystic papillary neoplasm of the gallbladder resembling a submucosal tumor

Ryo Muranushi  1 , Hideyuki Saito  2 , Asuka Matsumoto  2 , Toshihide Kato  2 , Naritaka Tanaka  2 , Kenji Nakazato  2 , Nobuhiro Morinaga  2 , Yoshinori Shitara  2 , Masatoshi Ishizaki  2 , Takatomo Yoshida  3 , Shinichi Aishima  4 , Ken Shirabe  5
Affiliations

A case report of intracholecystic papillary neoplasm of the gallbladder resembling a submucosal tumor

Ryo Muranushi et al. Surg Case Rep. .

Abstract

Background: Intracholecystic papillary neoplasm (ICPN) is defined as papillary tumors detected macroscopically in the gallbladder. We report a case of ICPN which exhibited the atypical form like a submucosal tumor.

Case presentation: A 70-year-old man was admitted to our hospital because of hepatic disorder. Computed tomography and magnetic resonance imaging showed irregular thickening of the wall within the gallbladder fundus. Because the lesion might have been malignant, we performed laparoscopic cholecystectomy and liver bed resection. Macroscopic findings showed the mucosal surface of the tumor was smooth, and its form was similar to that of a submucosal tumor. Histopathological examination revealed papillary tumors within the mass with low-grade dysplasia; therefore, we diagnosed ICPN.

Conclusion: In the present case, ICPN was resembling a submucosal tumor macroscopically because the tumors arose into the Rokitansky-Aschoff sinus and the adenomyomatous hyperplasia was merged with the ICPN. It is necessary to consider the possibility of tumor lesions within adenomyomatous hyperplasia.

Keywords: Adenomyomatous hyperplasia; Intracholecystic papillary neoplasm; Laparoscopic cholecystectomy.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Preoperative imaging findings. a Abdominal ultrasonography showed an 8 × 7-mm solid mass at the gallbladder fundus. b Enhanced CT showed that irregular wall thickening at the gallbladder fundus, and the boundary between the tumor and liver was indistinct. c T2-weighted MRI showed high-intensity nodules inside the thickened wall of the gallbladder
Fig. 2
Fig. 2
Photograph of resected specimen. It shows the gallbladder fundus on the left side and the cystic duct on the right side. A 15 × 10-mm mass like a submucosal tumor is visible within the gallbladder fundus (arrow), and its cut surface shows the papillary lesions
Fig. 3
Fig. 3
Histopathological findings. a Papillary tumors with cyst formation which presented mucin secretion were detected, and the Rokitansky-Aschoff sinus was formed (hematoxylin-eosin staining, × 40). b The smooth muscle became hyperplastic in the stromal tissue surrounding the papillary tumors (circle) (hematoxylin-eosin staining, × 100). b Epithelial cells. The nucleus chromatin increased, the karyotype was irregular, and the nuclear body became clear, showing low-grade dysplasia. (Hematoxylin-eosin staining, × 400)
Fig. 4
Fig. 4
Immunohistochemical analysis of mucosal characteristics. a MUC1 was positive; b MUC2 was negative; c MUC5AC was positive; and d MUC6 was positive
See this image and copyright information in PMC

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