{"entity":{"id":"gallbladder-carcinoma-in-situ-and-dysplasia","kind":"cancer","name":"Carcinoma in situ and dysplasia of the gallbladder","aka":["Biliary intraepithelial neoplasia of the gallbladder","BilIN","High-grade dysplasia of the gallbladder","Low-grade dysplasia of the gallbladder","Tis gallbladder cancer","Stage 0 gallbladder cancer"],"tldr":"Dysplasia means the cells lining the gallbladder have become abnormal but have not invaded; carcinoma in situ (stage 0) is the most abnormal form, with cancer cells still confined to the lining. Both are found by the pathologist after a gallbladder is removed and are cured by that removal when the margin is clear. Cancer Research UK notes some doctors do not regard stage 0 as a true cancer.","summary":"Gallbladder cancer develops through a metaplasia, dysplasia, carcinoma sequence in chronically inflamed mucosa (Lewis 2007; Hundal 2014). The WHO classification (5th edition, 2019; Nagtegaal 2020) names the flat precursor biliary intraepithelial neoplasia, graded low or high, with high-grade lesions equivalent to carcinoma in situ, and the mass-forming precursor the intracholecystic papillary neoplasm (Adsay 2012). In TNM 8th edition carcinoma in situ is Tis, stage 0: cancer cells confined to the lining with no invasion, rarely found except when a gallbladder is removed for other reasons (CRUK stages and grades). Early carcinomas confined to or above the muscle layer (Tis, T1a, T1b) are usually invisible to the naked eye (60 percent of 190 cases), occur about a decade younger than advanced cancers (mean 57.9 years) and have excellent outcomes: 92.3 percent five-year and 90.4 percent ten-year survival in a high-incidence series that sampled every specimen fully. The exception is extension of the intraepithelial tumour into Rokitansky-Aschoff sinuses, present in 17.8 percent, after which 39 percent died of disease against 4 percent without, often years later (Roa 2013). In primary sclerosing cholangitis dysplasia and carcinoma are common enough (37 and 14 percent of explanted gallbladders) that guidelines advise cholecystectomy for any polyp; a later cohort found most such polyps benign and proposed short-interval surveillance before surgery in the absence of high-risk features (Lewis 2007; van Erp 2020).\n\nWhat differs in treatment: Tis with a clear cystic duct margin needs no operation beyond the cholecystectomy already done. A positive cystic duct margin, or high-grade dysplasia running into the cystic duct, prompts consideration of bile duct margin re-excision, and Rokitansky-Aschoff sinus involvement is a reason to consider further surgery and to follow the patient for years (Roa 2013). The pathology protocol matters: at least three sections and the cystic duct margin from every routine specimen in high-incidence settings, and complete embedding when dysplasia or cancer is found (Aloia 2015).","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Carcinoma_in_situ","links":[{"label":"CRUK: stages and grades of gallbladder cancer","url":"https://www.cancerresearchuk.org/about-cancer/gallbladder-cancer/stages-and-grades"},{"label":"Roa, Virchows Arch 2013: early gallbladder carcinoma and Rokitansky-Aschoff sinus involvement","url":"https://doi.org/10.1007/s00428-013-1478-1"},{"label":"Lewis, Am J Surg Pathol 2007: gallbladder neoplasia in primary sclerosing cholangitis explants","url":"https://doi.org/10.1097/01.pas.0000213435.99492.8a"},{"label":"van Erp, Liver Int 2020: gallbladder polyps and cancer risk in primary sclerosing cholangitis","url":"https://doi.org/10.1111/liv.14326"},{"label":"Adsay, Am J Surg Pathol 2012: intracholecystic papillary-tubular neoplasms, 123 cases","url":"https://doi.org/10.1097/pas.0b013e318262787c"},{"label":"Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system","url":"https://doi.org/10.1111/his.13975"},{"label":"AHPBA expert consensus statement on gallbladder cancer (Aloia, HPB 2015)","url":"https://doi.org/10.1111/hpb.12444"},{"label":"Hundal and Shaffer, Clin Epidemiol 2014: gallbladder cancer epidemiology and outcome","url":"https://doi.org/10.2147/clep.s37357"}],"tags":["gallbladder","biliary","subtype-page"],"related":["gallbladder","incidental-gallbladder-cancer","gallbladder-papillary-carcinoma","gallbladder-adenocarcinoma"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["carcinoma-in-situ","dysplasia","rokitansky-aschoff-sinus","cystic-duct-margin","gallbladder-polyp"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"gastrointestinal","burden":"Almost always an incidental pathology finding. In 100 consecutive liver explants for primary sclerosing cholangitis, 37 percent of gallbladders showed dysplasia (15 high grade) and 14 percent adenocarcinoma (Lewis 2007); in the general population the frequency is far lower and not reliably measured.","subtypes":["Low-grade biliary intraepithelial neoplasia (dysplasia) of the gallbladder","High-grade biliary intraepithelial neoplasia, carcinoma in situ of the gallbladder (Tis, stage 0)","Carcinoma in situ extending into Rokitansky-Aschoff sinuses","Gallbladder dysplasia in primary sclerosing cholangitis"],"biomarkers":["Grade of dysplasia (low or high)","Absence of invasion through the basement membrane (Tis) versus lamina propria invasion (T1a)","Cystic duct margin status","Rokitansky-Aschoff sinus involvement","Pyloric and intestinal metaplasia in the background mucosa"],"standardOfCare":[{"setting":"Tis or dysplasia with a clear cystic duct margin","approach":"No further surgery; follow-up because occasional late recurrences reflect a field effect.","refs":["simple-cholecystectomy","cystic-duct-margin"]},{"setting":"Positive cystic duct margin or Rokitansky-Aschoff sinus involvement","approach":"Consider bile duct margin re-excision or further surgery at a hepatobiliary centre.","refs":["cystic-duct-margin","rokitansky-aschoff-sinus","radical-cholecystectomy"]},{"setting":"Gallbladder polyp in primary sclerosing cholangitis","approach":"Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present.","refs":["gallbladder-polyp","simple-cholecystectomy"]}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"gallbladder"},"route":"/cancers/gallbladder-carcinoma-in-situ-and-dysplasia/","neighbours":{"cancer":[{"id":"gallbladder-adenocarcinoma","kind":"cancer","name":"Gallbladder adenocarcinoma","route":"/cancers/gallbladder-adenocarcinoma/"},{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"},{"id":"incidental-gallbladder-cancer","kind":"cancer","name":"Incidental gallbladder cancer (found after cholecystectomy)","route":"/cancers/incidental-gallbladder-cancer/"},{"id":"gallbladder-papillary-carcinoma","kind":"cancer","name":"Papillary carcinoma of the gallbladder","route":"/cancers/gallbladder-papillary-carcinoma/"}],"term":[{"id":"carcinoma-in-situ","kind":"term","name":"Carcinoma in situ (CIS)","route":"/terms/carcinoma-in-situ/"},{"id":"cystic-duct-margin","kind":"term","name":"Cystic duct margin","route":"/terms/cystic-duct-margin/"},{"id":"dysplasia","kind":"term","name":"Dysplasia (pre-cancerous change)","route":"/terms/dysplasia/"},{"id":"gallbladder-polyp","kind":"term","name":"Gallbladder polyp (polypoid lesion)","route":"/terms/gallbladder-polyp/"},{"id":"radical-cholecystectomy","kind":"term","name":"Radical (extended) cholecystectomy","route":"/terms/radical-cholecystectomy/"},{"id":"rokitansky-aschoff-sinus","kind":"term","name":"Rokitansky-Aschoff sinus","route":"/terms/rokitansky-aschoff-sinus/"},{"id":"simple-cholecystectomy","kind":"term","name":"Simple cholecystectomy","route":"/terms/simple-cholecystectomy/"}]}}