title: An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.
abstract: Invasive pancreatic ductal adenocarcinoma is an almost uniformly fatal disease. Several distinct noninvasive precursor lesions can give rise to invasive adenocarcinoma of the pancreas, and the prevention, detection, and treatment of these noninvasive lesions offers the potential to cure early pancreatic cancers. Noninvasive precursors of invasive ductal adenocarcinoma of the pancreas include pancreatic intraepithelial neoplasias (PanINs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms. Diagnostic criteria, including a distinct ovarian-type stroma, and a consistent nomenclature are well established for mucinous cystic neoplasms. By contrast, consistent nomenclatures and diagnostic criteria have been more difficult to establish for PanINs and IPMNs. Because both PanINs and IPMNs consist of intraductal neoplastic proliferations of columnar, mucin-containing cells with a variable degree of papilla formation, the distinction between these two classes of precursor lesions remains problematic. Thus, considerable ambiguities still exist in the classification of noninvasive neoplasms in the pancreatic ducts. A meeting of international experts on precursor lesions of pancreatic cancer was held at The Johns Hopkins Hospital from August 18 to 19, 2003. The purpose of this meeting was to define an international acceptable set of diagnostic criteria for PanINs and IPMNs and to address a number of ambiguities that exist in the previously reported classification systems for these neoplasms. We present a consensus classification of the precursor lesions in the pancreatic ducts, PanINs and IPMNs.
authors.affiliation: Department of Pathology, The Johns Hopkins Medical Institutions, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410, USA. rhruban@jhmi.edu
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.forename: David S
authors.initials: DS
authors.lastname: Klimstra
authors.forename: N Volkan
authors.initials: NV
authors.lastname: Adsay
authors.forename: Jorge
authors.initials: J
authors.lastname: Albores-Saavedra
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Biankin
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Biankin
authors.forename: Carolyn
authors.initials: C
authors.lastname: Compton
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Fukushima
authors.forename: Toru
authors.initials: T
authors.lastname: Furukawa
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Yo
authors.initials: Y
authors.lastname: Kato
authors.forename: Gunter
authors.initials: G
authors.lastname: Klöppel
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Longnecker
authors.forename: Jutta
authors.initials: J
authors.lastname: Lüttges
authors.forename: Anirban
authors.initials: A
authors.lastname: Maitra
authors.forename: G Johan A
authors.initials: GJ
authors.lastname: Offerhaus
authors.forename: Michio
authors.initials: M
authors.lastname: Shimizu
authors.forename: Suguru
authors.initials: S
authors.lastname: Yonezawa
mesh_terms: D002278:Carcinoma in Situ / Q000145:classification* / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000145:classification* / Q000473:pathology; D032921:Consensus; D018282:Cystadenocarcinoma, Mucinous / Q000145:classification* / Q000473:pathology; D018283:Cystadenocarcinoma, Papillary / Q000145:classification* / Q000473:pathology; D006801:Humans; D010190:Pancreatic Neoplasms / Q000145:classification* / Q000473:pathology; D017410:Practice Guidelines as Topic