title: The Prevalence and Clinicopathological Characteristics of High-Grade Pancreatic Intraepithelial Neoplasia: Autopsy Study Evaluating the Entire Pancreatic Parenchyma.
abstract: We sought to identify clinicopathological characteristics of high-grade pancreatic intraepithelial neoplasia (PanIN)/carcinoma in situ to facilitate screening for pancreatic ductal adenocarcinoma.
  
  
  
  We evaluated PanIN lesions in 173 consecutive autopsy cases with no evidence of pancreatic ductal adenocarcinoma and/or intraductal papillary mucinous neoplasm (mean age, 80.5 years) by submitting the entire pancreas for microscopic examination.
  
  
  
  PanIN-3 was found in 4% of examined cases, whereas PanIN-1 and PanIN-2 were present in 77% and 28%, respectively. PanIN-3 was more frequently identified in patients with diabetes mellitus and/or older age. PanIN-3 lesions were always multifocal, and the number of PanIN-3 foci was positively associated with those of PanIN-1 or PanIN-2. PanIN-3 was located more frequently in the pancreatic body and tail than in the head and predominantly involved small interlobular/intralobular ducts rather than the main duct. Notably, 71% of pancreata with PanIN-3 showed cystic changes in PanIN-3 and lower grade PanIN lesions. PanIN-3 was also accompanied by higher grade extralobular fibrosis.
  
  
  
  We found that 4% of the examined pancreata harbored PanIN-3 lesions that were associated with several unique clinicopathological features. The cystic change along with fibrotic pancreatic parenchyma may be detected by imaging studies such as endoscopic ultrasound.
authors.affiliation: From the *Department of Pathology, Tokyo Metropolitan Geriatric Hospital; †Institute for Integrated Medical Sciences, Tokyo Women's Medical University; ‡Division of Cancer Genomics, National Cancer Center Research Institute; §Department of Endoscopy, Tokyo Metropolitan Geriatric Hospital; ∥Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo; ¶Department of Gastroenterological, General, Breast & Thyroid Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan; #Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Toru
authors.initials: T
authors.lastname: Furukawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishimura
authors.forename: Atsuko
authors.initials: A
authors.lastname: Seki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nonaka
authors.forename: Junko
authors.initials: J
authors.lastname: Aida
authors.forename: Kaiyo
authors.initials: K
authors.lastname: Takubo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishiwata
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Tomio
authors.initials: T
authors.lastname: Arai
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence