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Pancreatic Intraepithelial Neoplasia

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Pathology of the Pancreas

Abstract

The pancreatic intraepithelial neoplasia (PanIN) nomenclature and classification system, used to describe the microscopic epithelial precursor lesions of pancreatic ductal adenocarcinoma, replaced at least 70 different diagnostic terms for the same entities. The average time taken for the genetic progression from an initiating mutation in a normal ductal epithelial cell, through PanIN, to invasive ductal adenocarcinoma has been estimated to be 11.7 years. This chapter discusses the recently introduced two-tier classification, and the microscopic features, of PanIN, together with the differential diagnosis, including intraductal papillary mucinous neoplasia and cancerization of ducts.

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References

  1. Klimstra D, Longnecker DS. K-ras mutations in pancreatic ductal proliferative lesions. Am J Pathol. 1994;145:1547–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Hruban RH, Adsay NV, Albores-Saavedra J, Compton C, Garrett ES, Goodman SN, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol. 2001;25:579–86.

    Article  CAS  Google Scholar 

  3. Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977–87.

    Article  Google Scholar 

  4. Maitra A, Adsay NV, Argani P, Iacobuzio-Donahue C, De Marzo A, Cameron JL, et al. Multicomponent analysis of the pancreatic adenocarcinoma progression model using a pancreatic intraepithelial neoplasia tissue microarray. Mod Pathol. 2003;16:902–12.

    Article  Google Scholar 

  5. Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467:1114–7.

    Article  CAS  Google Scholar 

  6. Makohon-Moore AP, Matsukuma K, Zhang M, Reiter JG, Gerold JM, Jiao Y, et al. Precancerous neoplastic cells can move through the pancreatic ductal system. Nature. 2018;561:201–5.

    Article  CAS  Google Scholar 

  7. Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39:1730–41.

    Article  Google Scholar 

  8. Lokuhetty D, White VA, Watanabe R, Cree IA, editors. Digestive system tumours. WHO classification of tumours 5th edition. Lyon: IARC Press; 2019. p. 296.

    Google Scholar 

  9. Albores-Saavedra J, Wu J, Crook T, Amirkhan RH, Jones L, Hruban RH. Intestinal and oncocytic variants of pancreatic intraepithelial neoplasia. A morphological and immunohistochemical study. Ann Diagn Pathol. 2005;9:69–76.

    Article  Google Scholar 

  10. Albores-Saavedra J, Weimersheimer-Sandoval M, Chable-Montero F. Montante-Montes de Oca D, Hruban RH, Henson DE. The foamy variant of pancreatic intraepithelial neoplasia. Ann Diagn Pathol. 2008;12:252–9.

    Article  Google Scholar 

  11. Rebours V, Gaujoux S, d’Assignies G, Sauvanet A, Ruszniewski P, Levy P, et al. Obesity and fatty pancreatic infiltration are risk factors for pancreatic precancerous lesions (PanIN). Clin Cancer Res. 2015;21:3522–8.

    Article  CAS  Google Scholar 

  12. Hisa T, Suda K, Nobukawa B, Ohkubo H, Shiozawa S, Ishigame H, et al. Distribution of intraductal lesions in small invasive ductal carcinoma of the pancreas. Pancreatology. 2007;7:341–6.

    Article  Google Scholar 

  13. Ishii M, Kimura Y, Sugita S, Imamura M, Ito T, Nobuoka T, et al. Surgical and oncological impact of main pancreatic duct spread in invasive ductal adenocarcinoma: a clinicopathological study of 184 resected cases. Pancreatology. 2015;15:681–7.

    Article  Google Scholar 

  14. Rebours V, Lévy P, Mosnier JF, Scoazec JY, Soubeyrand MS, Fléjou JF, et al. Pathology analysis reveals that dysplastic pancreatic ductal lesions are frequent in patients with hereditary pancreatitis. Clin Gastroenterol Hepatol. 2010;8:206–12.

    Article  Google Scholar 

  15. Shi C, Klein AP, Goggins M, Maitra A, Canto M, Ali S, et al. Increased prevalence of precursor lesions in familial pancreatic cancer patients. Clin Cancer Res. 2009;15:7737–43.

    Article  CAS  Google Scholar 

  16. Detlefsen S, Sipos B, Feyerabend B, Klöppel G. Pancreatic fibrosis associated with age and ductal papillary hyperplasia. Virchows Arch. 2005;447:800–5.

    Article  Google Scholar 

  17. Tanaka M, Castillo F-d, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–53.

    Article  Google Scholar 

Further Reading

  • Basturk O, Esposito I, Fukushima N, Furukawa T, Hong SM, Klöppel G, et al. Pancreatic intraepithelial neoplasia. In: Lokuhetty D, White VA, Watanabe R, Cree IA, editors. Digestive system tumours. WHO classification of tumours 5th edition. Lyon: IARC Press; 2019. p. 307–9.

    Google Scholar 

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Correspondence to Fiona Campbell .

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Campbell, F., Verbeke, C.S. (2021). Pancreatic Intraepithelial Neoplasia. In: Pathology of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-030-49848-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-49848-1_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-49847-4

  • Online ISBN: 978-3-030-49848-1

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