{"entity":{"id":"paper-adsay-icpn-gallbladder-ajsp-2012","kind":"paper","name":"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","aka":[],"tldr":"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%.\n\nOf 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.","asOf":"2026-09-24","links":[{"label":"Adsay et al., Am J Surg Pathol 2012: intracholecystic papillary-tubular neoplasms, 123 cases","url":"https://doi.org/10.1097/pas.0b013e318262787c"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/22895264/"}],"tags":[],"related":[],"cancers":["gallbladder"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["intracholecystic-papillary-tubular-neoplasm","dysplasia"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"American Journal of Surgical Pathology","year":2012,"doi":"10.1097/pas.0b013e318262787c","pmid":"22895264","authors":"Adsay V, Jang KT, Roa JC, et al.","paperType":"observational","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."],"whatItMeans":"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."],"changedPractice":true,"participants":123},"route":"/key-papers/paper-adsay-icpn-gallbladder-ajsp-2012/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"}],"term":[{"id":"dysplasia","kind":"term","name":"Dysplasia (pre-cancerous change)","route":"/terms/dysplasia/"},{"id":"intracholecystic-papillary-tubular-neoplasm","kind":"term","name":"Intracholecystic papillary-tubular neoplasm (ICPN)","route":"/terms/intracholecystic-papillary-tubular-neoplasm/"}]}}