title: Clinical profile of PanIN lesions in tropical chronic pancreatitis.
abstract: BACKGROUND
  Chronic pancreatitis (CP) found in the tropical countries is known to have a higher risk for carcinoma of the pancreas. This study aimed to explore the clinical profile of pancreatic intraepithelial neoplasia (PanIN), one of the precursors of carcinoma of the pancreas, in tropical CP and to identify the possible clinical predictors of the same.
  
  
  METHODS
  A retrospective study was done enrolling patients who underwent either Frey's procedure or pancreatic resection for symptomatic CP, between January 2008 and December 2012. They were grouped into PanIN positive and PanIN negative based on histopathology. Their clinical and laboratory parameters were compared statistically to identify the predictors of the PanIN status.
  
  
  RESULTS
  Sixty-two tropical CP patients who had Frey's procedure or pancreatic resection were enrolled into this study; 38.7 % cases showed PanIN changes and 61.29 % had no PanIN changes. Majority of the clinical and laboratory parameters were found comparable between the two groups except obstructive jaundice and CA 19-9 value >137.5 which were there in 54.2 % of PanIN-positive cases. On histopathology, 54.83 % cases were benign CP and 45.16 % were malignant CP. Among the benign CP, 33.3 % were PanIN positive and among those with malignancy 66.7 % were PanIN positive. Low-grade PanINs were seen in 73 % cases of benign CP and in 26.1 % of malignancy whereas high-grade PanIN-3 lesions were seen exclusively in patients with malignancy.
  
  
  CONCLUSIONS
  High-grade PanIN-3 lesions showed significant association with pancreatic malignancy. Obstructive jaundice and CA 19-9 ≥ 137.5 could predict PanIN positivity.
authors.affiliation: Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India. sindhurs@hotmail.com.
authors.forename: R S
authors.initials: RS
authors.lastname: Sindhu
authors.affiliation: Department of Pathology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: G
authors.initials: G
authors.lastname: Parvathy
authors.affiliation: Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: K
authors.initials: K
authors.lastname: Fysal
authors.affiliation: Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Jacob
authors.affiliation: Department of Pathology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: S
authors.initials: S
authors.lastname: Geetha
authors.affiliation: Department of Pathology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: B
authors.initials: B
authors.lastname: Krishna
authors.affiliation: Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: Bonny
authors.initials: B
authors.lastname: Natesh
authors.affiliation: Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Rajan
mesh_terms: D000328:Adult; D002278:Carcinoma in Situ / Q000473:pathology*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000473:pathology* / Q000601:surgery; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014329:Tropical Climate
keywords: CA 19-9; Malignant chronic pancreatitis; PanIN lesions; Precancerous lesions; Predictors of malignancy; Tropical chronic pancreatitis