# Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are at least 1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases

Source: https://onco.cc/key-papers/paper-adsay-icpn-gallbladder-ajsp-2012/  
OnCo record `paper-adsay-icpn-gallbladder-ajsp-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Polyp-like growths of the gallbladder lining 1 cm or larger were reclassified as one family, ICPN: more than half already contained invasive cancer, yet those cancers fared much better than ordinary gallbladder carcinoma.

## Summary

123 gallbladder cases with a well-defined exophytic preinvasive neoplasm of 1 cm or more were analysed. Patients were predominantly female (2 to 1) with a mean age of 61 and a median tumour size of 2.2 cm; half presented with pain and half incidentally; gallstones were present in only 20%; radiology called almost half cancer and missed 10%. Configuration was papillary in 43%, tubulopapillary in 31% and tubular in 26%, and cell lineage biliary in 50%, gastric foveolar 16%, gastric pyloric 20%, intestinal 8% and oncocytic 6%, with hybrid patterns in 90%.

Of cases that would have qualified as pyloric gland adenoma, 88% had at least focal high-grade dysplasia and 18% invasive carcinoma. Overall 55% had an associated invasive carcinoma; extent of high-grade dysplasia, biliary or foveolar cell type and papilla formation were associated with invasion. Among systematically analysed invasive carcinomas, a tumoral intraepithelial neoplasm was detected in 6.4% (39 of 606). Three-year survival was 90% without and 60% with invasion, against 27% for pancreatobiliary-type gallbladder carcinoma, an advantage that persisted after stage matching.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: American Journal of Surgical Pathology
- Year: 2012
- DOI: 10.1097/pas.0b013e318262787c
- Authors: Adsay V, Jang KT, Roa JC, et al.
- Findings: 55% of 123 ICPNs harboured invasive carcinoma; 88% of pyloric gland adenoma-like lesions had high-grade dysplasia.; Three-year survival 90% (no invasion), 60% (invasion) versus 27% for pancreatobiliary-type carcinoma.; Only 6.4% (39 of 606) of invasive carcinomas arose from a tumoral precursor.
- What it means: This paper created the ICPN category adopted by the WHO classification and quantified the polyp route: rare as an origin of cancer, dangerous when present, and better in outcome. It underpins the 1 cm threshold for removing gallbladder polyps.
- Caveats: Multi-institutional pathology series with referral bias.; Lineage assignment relied on predominant pattern and immunohistochemistry.

## Sources

- Adsay et al., Am J Surg Pathol 2012: intracholecystic papillary-tubular neoplasms, 123 cases: https://doi.org/10.1097/pas.0b013e318262787c
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22895264/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- terms: [Dysplasia (pre-cancerous change)](https://onco.cc/terms/dysplasia/), [Intracholecystic papillary-tubular neoplasm (ICPN)](https://onco.cc/terms/intracholecystic-papillary-tubular-neoplasm/)

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