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Pyloric Gland Adenoma of Gallbladder: A Review of Diagnosis and Management

Farid Saei Hamedani

Introduction: Neoplastic polyps of the gallbladder are commonly asymptomatic. However, advances in radiologic modalities and their growing use for various clinical indications have increased the number of gallbladder polyps being diagnosed and reported. Yet, due to lack of unified terminology and reporting criteria, the body of scientific evidence regarding their classification and management is scarce and even sometimes controversial. The plethora of terminology used in scientific literature to describe these lesions includes “pyloric gland adenoma,” “tubulopapillary adenoma,” and “biliary adenoma”. Even though this diverse group of lesions shares histological and immunohistochemical characteristics, they are distinct entities with different cellular lineages and a spectrum of dysplasia which makes their prognosis different. Histologically, these lesions are classified as the gastric pyloric gland, gastric foveolar, intestinal, and biliary, with the pyloric subtype being the most common lesion (82%). Adsay et al. are the first group of investigators who proposed the unified terminology of intracholecystic papillary-tubular neoplasms (ICPNs) to describe neoplastic polyps of the gallbladder. They used the size of over 1 cm as an inclusion criterion as this size has been used in other lesions of the pancreatobiliary system like intraductal papillary mucinous neoplasms (IPMN). In the surgical literature, patients with polyps of over 1 cm are often being elected to go through cholecystectomies. Adsay and colleagues used 25% and 75% tubule or papillary formation as cutoff points to categorize ICPNs based on their growth patterns, and so 43% of their cohort qualified as papillary, 26% as tubular, and 31% as tubulopapillary. The mean sizes of the papillary, tubulopapillary, and tubular polyps were reported as 2.8 cm, 2.7 cm, and 2 cm, respectively. It is explainable, as in other parts of the gastrointestinal tract, smaller lesions are usually more tubular and papillary lesions are often larger.

Background: They reported the biliary type as the most common (50%) and pyloric gland subtype (simple mucinous and complex