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Histopathology. 2019 May 11. doi: 10.1111/his.13897. [Epub ahead of print]

Multiple KRAS Mutations in the Non-Mucinous Epithelial Lining in the Majority of Mucinous Cystic Neoplasms of the Pancreas.

Author information

1
Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
2
Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea.
3
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
4
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
5
Department of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
6
Department of Oncology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Abstract

AIMS:

Mucinous cystic neoplasms (MCNs) of the pancreas are cystic neoplasms lined by mucinous lining epithelium (MLE) with associated ovarian-type stroma. Although a non-MLE (NMLE) could be observed in some MCNs, whether cystic neoplasms with ovarian-type stroma and NMLE should be classified as MCNs or separately designated is debated.

METHODS AND RESULTS:

NMLEs were defined as flat or cuboidal epithelial cells without intracytoplasmic mucin. A total of 112 MCNs were reviewed, and the epithelium was classified as NMLE or MLE. A total of 110 females and two males with a mean age of 46.5 ± 12.3 years were included in this study. At least focal NMLE was noted in 76.8% (86/112) of MCNs. The mean percentage of the neoplastic epithelium that was NMLE in these 86 cases was 46%. NMLE was predominant (>50%) in 38.4% (43/112) cases. MCNs with NMLE were smaller (4.2 ± 2.1 cm) than those with MLE (6.0 ± 3.6 cm, P < 0.001), and all NMLEs had low-grade dysplasia. Twelve MCNs with NMLE or MLE were selected for KRAS mutation analysis using droplet digital polymerase chain reaction after laser capture microdissection. All 12 MCNs exhibited multiple types of KRAS mutations, which were detected in 92% (11/12) of NMLE foci and 89% (8/9) of MLE foci. Predominant NMLE was common in small MCNs with low-grade dysplasia.

CONCLUSIONS:

Clonal KRAS mutations were observed in both NMLE and MLE, supporting the hypothesis that MCNs with NMLE should be classified as MCNs. This article is protected by copyright. All rights reserved.

KEYWORDS:

KRAS ; epithelium; mucinous cystic neoplasm; non-mucinous; pancreas

PMID:
31077597
DOI:
10.1111/his.13897

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