Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone
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CASE REPORT
Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone removal by percutaneous transhepatic choledochoscopy: a case report Chi Hyuk Oh* and Seok Ho Dong
Abstract Background: Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are rare, preinvasive lesions characterized by an intracholecystic papillary growth that may be associated with invasive adenocarcinoma. The natural history of ICPN is unknown. Here, we report a case of ICPN, highlighting its natural course. Case presentation: A 79-year-old woman presented to the emergency department with perforated cholecystitis. After percutaneous transhepatic gallbladder drainage, due to the presence of surgical risk factors, we opted to perform gallstone removal through percutaneous transhepatic cholangioscopy instead of cholecystectomy. ICPN, which was accidentally detected after the removal of the gallbladder stones, was also endoscopically removed. After 4 years, the patient came back to the hospital with a large gallbladder mass. After cholecystectomy, pathological examination revealed ICPN with invasive adenocarcinoma. Conclusion: The current case showed endoscopic findings of ICPN and its natural progression, particularly its clinicopathological features and outcomes. Keywords: Intracholecystic papillary neoplasm, Gallbladder, Gallbladder cancer, Acute cholecystitis, Cholecystolithiasis Background Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are suspected to be similar to intraductal papillary neoplasms of the bile duct (IPNBs) and intraductal papillary mucinous neoplasms (IPMNs) of the pancreas [1]. ICPNs are rare premalignant lesions characterized by a papillary growth in the gallbladder [2]. Here, we report a unique case wherein progression to invasive ICPN *Correspondence: [email protected] Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, 23, Kyungheedae‑ro, Dongdaemun‑gu, Seoul 02447, South Korea
occurred 4 years after the endoscopic resection of ICPN of the gallbladder.
Case presentation A 79-year-old woman with a recent history of acute myocardial infarction presented with abdominal pain, fever, and altered mental status. The vital signs included the following: blood pressure, 80/60 mmHg; heart rate, 118 beats/min; and body temperature, 39.2 °C. A laboratory analysis showed leukocytosis (white blood cell count, 24,000/μL; seg-neutrophils, 89%) and elevated levels of C-reactive protein (35.30 mg/dL; normal range:
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