title: Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer.
abstract: 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 PanINs, even the low-grade PanIN-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. PanINs 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.
authors.affiliation: Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA.
authors.forename: Kieran
authors.initials: K
authors.lastname: Brune
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Abe
authors.forename: Marcia
authors.initials: M
authors.lastname: Canto
authors.forename: Lauren
authors.initials: L
authors.lastname: O'Malley
authors.forename: Alison P
authors.initials: AP
authors.lastname: Klein
authors.forename: Anirban
authors.initials: A
authors.lastname: Maitra
authors.forename: N
authors.initials: N
authors.lastname: Volkan Adsay
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kern
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology; D000328:Adult; D000368:Aged; D001284:Atrophy; D002278:Carcinoma in Situ / Q000473:pathology; D002291:Carcinoma, Papillary / Q000473:pathology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000235:genetics*; D011230:Precancerous Conditions / Q000473:pathology*; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D014057:Tomography, X-Ray Computed; D018631:ras Proteins
chemical_list: C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins