Background
Main duct intraductal papillary mucinous neoplasms (MD-IPMNs) may occur in 1 or multiple
segments of the pancreatic duct. Unlike multifocal branch duct (BD)-IPMNs, the clonality
of multisegmental MD-IPMNs remains unclear. GNAS mutations are common and specific
for IPMNs, and mutational assessment might be useful to determine the clonality of
IPMNs as well as to detect high-risk IPMN with distinct ductal adenocarcinoma (pancreatic
ductal adenocarcinoma [PDAC]). Our aim was to clarify clonality using GNAS status
in multisegmental MD-IPMNs.
Methods
We retrospectively reviewed the medical records of 70 patients with MD-IPMN. Histologic
subtypes and KRAS/GNAS mutations were investigated, and the clonal relationships among
multisegmental MD-IPMNs were assessed. Mutational analysis was performed using high-resolution
melting analysis and subsequent Sanger/pyrosequencing.
Results
Thirteen patients had multiple synchronous and/or metachronous lesions. Seven of these
13 patients had multiple MD-IPMNs; 3 had multiple MD-IPMNs and distinct BD-IPMNs;
1 had multiple MD-IPMNs and a distinct PDAC; 1 had a solitary MD-IPMN, BD-IPMN, and
PDAC; and 1 had a solitary MD-IPMN and PDAC. KRAS/GNAS mutations were consistent in
10 of 11 multisegmental MD-IPMNs, whereas MD-IPMNs, BD-IPMNs, and PDACs tended to
show different mutational patterns. The frequency of malignant IPMNs was significantly
higher in the multisegment cohort; malignant IPMNs constituted 90% (9/10) of the multiple
cohort and 56% (32/57) of the solitary cohort (P = .04). Mutant GNAS was more frequently observed in the intestinal subtype (94%)
than the others.
Conclusion
MD-IPMNs can be characterized by monoclonal skip progression. Close attention should
be paid to the possible presence of skip areas during or after partial pancreatectomy.
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Article info
Publication history
Published online: December 16, 2014
Accepted:
September 10,
2014
Footnotes
Conflicts of interest and source of funding: The authors declare no conflicts of interest. This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Numbers 24390318, 24390319, 23390327, 25293285, 25670586, 25670585, 25670584, 25670582, and 24592030.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
