title: Disease spectrum of intraductal papillary mucinous neoplasm with an associated invasive carcinoma invasive IPMN versus pancreatic ductal adenocarcinoma-associated IPMN.
abstract: OBJECTIVE
  Current version of World Health Organization classification introduced the concept of ‘‘intraductal papillary mucinous neoplasm(IPMN) with an associated invasive carcinoma.’’ The authors investigated the clinicopathologic characteristics and prognosis of this disease category according to tumor morphology and percentage of invasive component.
  
  
  METHODS
  Fifty-nine patients who underwent surgical resection of IPMN with an associated invasive carcinoma at Seoul National University Hospital were subgrouped according to the invasive component of less than 5% (minimally invasive [MI] intraductal papillary mucinous carcinoma [IPMC] [MI-IPMC]), 5%- 50% (invasive IPMC [IPMC-I]),and 50% or greater (pancreatic ductal adenocarcinoma [PDAC]-associated IPMN [PDAC-IPMN]). Prognosis was compared with 219 curatively resected conventional PDAC.
  
  
  RESULTS
  Eleven MI-IPMCs (18.6%), 24 IPMC-Is (40.7%), and 24PDAC-IPMNs (40.7%) were identified. With the transition from MIIPMC to IPMC-I and PDAC-IPMN, percentage of advanced T (P G0.001) or N stage (P = 0.001), expression of S100A4 (P = 0.004), p53(P = 0.028), and CD24 (P = 0.009) increased; and SMAD4 expression decreased (P G 0.001). The overall 5-year survival rates for MIIPMC,IPMC-I, and PDAC-IPMN were 80.8%, 59.0%, and 29.3%,respectively (P G 0.001). Pancreatic ductal adenocarcinoma-associated IPMN had poor prognosis compared with MI-IPMC (P = 0.011) or IPMC-I (P = 0.026) but had comparable prognosis with conventional PDAC (P = 0.138).
  
  
  CONCLUSIONS
  Pancreatic ductal adenocarcinoma-associated IPMN has different clinicopathological characteristics compared with the IPMC-I.Intraductal papillary mucinous neoplasm with an associated invasive carcinoma is composed of a wide spectrum of disease.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Kyoung Bun
authors.initials: KB
authors.lastname: Lee
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D055262:Mucin-2 / Q000378:metabolism; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011230:Precancerous Conditions / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: C060192:MUC1 protein, human; C524625:MUC2 protein, human; D018396:Mucin-1; D055262:Mucin-2; D016159:Tumor Suppressor Protein p53