Pancreatic Disorders & Therapy
Open Access

Abstract

The Role of Molecular Analysis in Diagnosis and Risk Stratification of Intraductal Papillary Mucinous Neoplasm?A Precursor to Pancreatic Adenocarcinoma

Vicente Morales-Oyarvide and Mari Mino-Kenudson

Pancreatic cancer is a leading cause of cancer death and most patients have advanced disease at the time of diagnosis, making early detection of paramount importance. Intraductal papillary mucinous neoplasm (IPMN) is a cystic precursor lesion to pancreatic cancer that is being diagnosed with increasing frequency often in asymptomatic patients. While some IPMNs may progress to invasive carcinoma and thus, require resection, others will remain insignificant and may be followed without surgical intravenation. Unfortunately, our understanding of the natural history of IPMN is limited, and we are not yet able to confidently segregate high-risk and malignant lesions from low-risk ones. Molecular profiling that allows us to gain insight into the biology of the disease may provide us with clues to improve preoperative decision making. In this review, we will discuss the most recent findings in the molecular alterations of IPMN including those in tumor suppressor genes and oncogenes, chromosomal copy number abnormalities, epigenetic alterations, and miRNAs, followed by the implementation of those markers in the analyses of cyst fluid that can be obtained via endoscopic ultrasound guided fine needle aspiration. We will also touch upon pancreatic duct glands (PDG), a possible cell origin of IPMN.