Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer

被引:7
作者
Brune, Kieran
Abe, Tadayoshi
Canto, Marcia
O'Malley, Lauren
Klein, Alison P.
Maitra, Anirban
Adsay, N. Volkan
Fishman, Elliot K.
Cameron, John L.
Yeo, Charles J.
Kern, Scott E.
Goggins, Michael
Hruban, Ralph H.
机构
[1] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Pathol, Baltimore, MD 21231 USA
[2] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Med, Baltimore, MD 21231 USA
[3] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Oncol, Baltimore, MD 21231 USA
[4] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Art Appl Med, Baltimore, MD 21231 USA
[5] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Radiol, Baltimore, MD 21231 USA
[6] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Surg, Baltimore, MD 21231 USA
[7] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Inst Genom Med, Baltimore, MD 21231 USA
[8] Wayne State Univ, Karmanos Canc Ctr, Dept Pathol, Detroit, MI USA
关键词
familial cancer; pancreatic cancer; pancreatic intraepithelial neoplasia; intraductal papillary mucinous neoplasm;
D O I
暂无
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
We screened 116 patients with a strong family history of pancreatic cancer using a combination of endoscopic ultrasound and computed tomography. Ten of these patients underwent surgical resection at our institution, providing an opportunity to define the morphology of pancreatic precursor lesions in patients with a strong family history of pancreatic cancer. Eight of the 10 pancreata were available and these were entirely submitted for histologic examination. The number of pancreatic intraepithelial neoplasia (PanIN) lesions and intraductal papillary mucinous neoplasms (IPMNs) were compared with age-matched controls. Parenchymal changes were defined. Selected precursor neoplasms from 6 pancreata were microdissected and analyzed for KRAS gene mutations. PanINs were significantly more common in the 8 cases (mean of 10.7% of the duct profiles, range 1.0% to 27.3%) than in the controls (mean 1.9%, range 0% to 9.2%, P < 0.01). Different KRAS gene mutations were identified in separately microdissected precursor lesions in 2 of 6 cases. IPMNs were identified in 4 of the 8 cases, including 2 pancreata each having 2 distinct IPMNs. Both the IPMNs and the PanlNs, even the low-grade PanlN-1 lesions, were associated with lobular Parenchymal atrophy. Some individuals with a strong family history of pancreatic cancer develop multifocal, noninvasive epithelial precursor lesions of the pancreas. PanlNs and IPMNs produce obstructive lobular atrophy, and this atrophy is likely the source of the chronic pancreatitis-like changes seen in these patients. The multifocal nature of familial pancreatic neoplasia suggests that surveillance of these patients is warranted after partial pancreatectomy.
引用
收藏
页码:1067 / 1076
页数:10
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