• pancreatic cancer
• pancreatic tumours
• genetic testing
• clinical decision making

Intraductal papillary mucinous neoplasms (IPMNs) represent the most common cystic preinvasive lesion in the pancreas, which can progress to invasive pancreatic ductal adenocarcinoma (PDAC). Patients with radiological findings consistent with IPMN are strictly monitored with imaging techniques, and surgical resection is recommended in case of clinical and/or radiological ‘high-risk stigmata’ or ‘worrisome features’.1 2 Recent research has suggested the potential role of molecular analysis of cyst fluid to discriminate IPMNs from other types of pancreatic cysts and from invasive lesions.3–6

Notably, recent evidences pointed out the presence of a so-called ‘field effect’ of pancreatic carcinogenesis. This concept indicates the occurrence of seemingly unrelated patches of non-neoplastic cells that may be partly shared with a tumour lesion.7 Therefore, within the pancreas not only a preinvasive lesion is at risk of progression to malignancy but independent preinvasive and invasive lesions may develop as well. In other words, the ‘field effect’ might separately predispose to both preinvasive and invasive lesions. Along this line, Pea and colleagues, sequenced DNA from a cohort of IPMNs and PDAC from the same patients, showing that a significant proportion of the recurrent cancers was likely independent from the primary resected IPMNs.8

The existence of a field-effect carcinogenesis in the pancreas has also been suggested by the work of Shindo and colleagues, who reported that germ line mutations in PDAC susceptibility genes are commonly identified in patients with pancreatic cancer, even when a family history of cancer is lacking.9 Some of these mutations …