Preoperative Diagnosis of Intracholecystic Papillary Neoplasm Based on Characteristic Preoperative Images: A Case Report

  • Miyashita Ryohei
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Shimizu Akira
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Kubota Koji
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Notake Tsuyoshi
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Hosoda Kiyotaka
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Umemura Kentaro
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Kamachi Atsushi
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Goto Takamune
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Tomida Hidenori
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University
  • Fukuda Hironobu
    Department of Pathology, Shinshu University
  • Soejima Yuji
    Department of Surgery, Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery Division, School of Medicine, Shinshu University

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Other Title
  • 特徴的な画像所見を示し術前に診断しえた浸潤性胆囊内乳頭状腫瘍の1例

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Abstract

<p>A 79-year-old woman underwent chest CT for follow-up of a nodular shadow in the lungs. The scan revealed a mass lesion in the gallbladder and she was referred to our department for further examination and treatment. The fundus of the gallbladder had a progressively contrasted tumor measuring more than 5 cm. Calcification was observed in the center of the stem. The tumor produced mucus with no peritumoral invasion. Thus, it was diagnosed as intracholecystic papillary neoplasm (ICPN), and extended cholecystectomy and sentinel lymphadenectomy were performed. Gross findings of the resected specimen showed a white papillary lesion with mucus accumulation and necrotic areas in the gallbladder cavity. Histopathological examination revealed ICPN with a mixture of low- and high-grade dysplasia and invasive carcinoma in a small area. Histologic subclassification led to diagnosis as a gastric type based on gross findings and MUC staining. Because of the micrometastasis in the #12c lymph node proved by pathological examinations, D2 lymph node dissection was added after the initial surgery.</p>

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