title: Molecular genetics of pancreatic neoplasms and their morphologic correlates: an update on recent advances and potential diagnostic applications.
abstract: OBJECTIVE
  To summarize the most clinically and biologically relevant advances in molecular/genetic characteristics of various pancreatic neoplasms, with morphologic correlation.
  
  
  METHODS
  Whole-exome sequencing of numerous benign and malignant pancreatic tumors, along with the plethora of highly sensitive molecular studies now available for analyzing these tumors, provide mounting evidence to support the long-held belief that cancer is essentially a genetic disease. These genetic discoveries have not only helped to confirm the age-old, morphology-based classifications of pancreatic neoplasia but have shed new light on their mechanisms. Many of these molecular discoveries are currently being used in preoperative diagnosis.
  
  
  RESULTS
  Mutations in KRAS, P16/CDKN2A, TP53, and SMAD4/DPC4 are commonly seen in ductal neoplasia but not in nonductal tumors; ductal adenocarcinomas with SMAD4/DPC4 loss are associated with widespread metastasis and poor prognosis. GNAS and RNF43 mutations have been discovered in most intraductal pancreatic mucinous neoplasms, providing critical molecular fingerprints for their diagnosis. Mutation in DAXX/ATRX is only seen in pancreatic neuroendocrine tumors, making it a useful potential marker in distinguishing these tumors from mimics.
  
  
  CONCLUSIONS
  When combined with morphologic observations, molecular studies will increase our understanding of the pathogenesis and morphomolecular signatures associated with specific neoplasms and provide new horizons for precision medicine and targeted therapies.
authors.affiliation: Dept of Pathology, Emory University Hospital, 1364 Clifton Rd, NE, Room H180, Atlanta, GA 30322; nadsay@emory.edu.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Reid
authors.forename: Burcu
authors.initials: B
authors.lastname: Saka
authors.forename: Serdar
authors.initials: S
authors.lastname: Balci
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Goldblum
authors.forename: N Volkan
authors.initials: NV
authors.lastname: Adsay
mesh_terms: D048430:Cell Shape; D006801:Humans; D008967:Molecular Biology / Q000639:trends*; D010190:Pancreatic Neoplasms / Q000235:genetics* / Q000473:pathology*
keywords: Molecular genetics; Pancreas; Pancreatic neoplasms