In:
Gut, BMJ, Vol. 67, No. 9 ( 2018-09), p. 1652-1662
Abstract:
Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions that can give rise to invasive pancreatic carcinoma. Although approximately 8% of patients with resected pancreatic ductal adenocarcinoma have a co-occurring IPMN, the precise genetic relationship between these two lesions has not been systematically investigated. Design We analysed all available patients with co-occurring IPMN and invasive intrapancreatic carcinoma over a 10-year period at a single institution. For each patient, we separately isolated DNA from the carcinoma, adjacent IPMN and distant IPMN and performed targeted next generation sequencing of a panel of pancreatic cancer driver genes. We then used the identified mutations to infer the relatedness of the IPMN and co-occurring invasive carcinoma in each patient. Results We analysed co-occurring IPMN and invasive carcinoma from 61 patients with IPMN/ductal adenocarcinoma as well as 13 patients with IPMN/colloid carcinoma and 7 patients with IPMN/carcinoma of the ampullary region. Of the patients with co-occurring IPMN and ductal adenocarcinoma, 51% were likely related. Surprisingly, 18% of co-occurring IPMN and ductal adenocarcinomas were likely independent, suggesting that the carcinoma arose from an independent precursor. By contrast, all colloid carcinomas were likely related to their associated IPMNs. In addition, these analyses showed striking genetic heterogeneity in IPMNs, even with respect to well-characterised driver genes. Conclusion This study demonstrates a higher prevalence of likely independent co-occurring IPMN and ductal adenocarcinoma than previously appreciated. These findings have important implications for molecular risk stratification of patients with IPMN.
Type of Medium:
Online Resource
ISSN:
0017-5749
,
1468-3288
DOI:
10.1136/gutjnl-2017-315062
DOI:
10.1136/gutjnl-2017-315062.supp1
DOI:
10.1136/gutjnl-2017-315062.supp2
DOI:
10.1136/gutjnl-2017-315062.supp3
DOI:
10.1136/gutjnl-2017-315062.supp4
DOI:
10.1136/gutjnl-2017-315062.supp5
DOI:
10.1136/gutjnl-2017-315062.supp6
DOI:
10.1136/gutjnl-2017-315062.supp7
DOI:
10.1136/gutjnl-2017-315062.supp8
DOI:
10.1136/gutjnl-2017-315062.supp9
DOI:
10.1136/gutjnl-2017-315062.supp10
DOI:
10.1136/gutjnl-2017-315062.supp11
DOI:
10.1136/gutjnl-2017-315062.supp12
DOI:
10.1136/gutjnl-2017-315062.supp13
DOI:
10.1136/gutjnl-2017-315062.supp14
DOI:
10.1136/gutjnl-2017-315062.supp15
DOI:
10.1136/gutjnl-2017-315062.supp16
DOI:
10.1136/gutjnl-2017-315062.supp17
Language:
English
Publisher:
BMJ
Publication Date:
2018
detail.hit.zdb_id:
1492637-4
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