TY - JOUR T1 - IPMNs with co-occurring invasive cancers: neighbours but not always relatives JF - Gut JO - Gut SP - 1652 LP - 1662 DO - 10.1136/gutjnl-2017-315062 VL - 67 IS - 9 AU - Matthäus Felsenstein AU - Michaël Noë AU - David L Masica AU - Waki Hosoda AU - Peter Chianchiano AU - Catherine G Fischer AU - Gemma Lionheart AU - Lodewijk A A Brosens AU - Antonio Pea AU - Jun Yu AU - Georgios Gemenetzis AU - Vincent P Groot AU - Martin A Makary AU - Jin He AU - Matthew J Weiss AU - John L Cameron AU - Christopher L Wolfgang AU - Ralph H Hruban AU - Nicholas J Roberts AU - Rachel Karchin AU - Michael G Goggins AU - Laura D Wood Y1 - 2018/09/01 UR - http://gut.bmj.com/content/67/9/1652.abstract N2 - Objective Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions that can give rise to invasive pancreatic carcinoma. Although approximately 8% of patients with resected pancreatic ductal adenocarcinoma have a co-occurring IPMN, the precise genetic relationship between these two lesions has not been systematically investigated.Design We analysed all available patients with co-occurring IPMN and invasive intrapancreatic carcinoma over a 10-year period at a single institution. For each patient, we separately isolated DNA from the carcinoma, adjacent IPMN and distant IPMN and performed targeted next generation sequencing of a panel of pancreatic cancer driver genes. We then used the identified mutations to infer the relatedness of the IPMN and co-occurring invasive carcinoma in each patient.Results We analysed co-occurring IPMN and invasive carcinoma from 61 patients with IPMN/ductal adenocarcinoma as well as 13 patients with IPMN/colloid carcinoma and 7 patients with IPMN/carcinoma of the ampullary region. Of the patients with co-occurring IPMN and ductal adenocarcinoma, 51% were likely related. Surprisingly, 18% of co-occurring IPMN and ductal adenocarcinomas were likely independent, suggesting that the carcinoma arose from an independent precursor. By contrast, all colloid carcinomas were likely related to their associated IPMNs. In addition, these analyses showed striking genetic heterogeneity in IPMNs, even with respect to well-characterised driver genes.Conclusion This study demonstrates a higher prevalence of likely independent co-occurring IPMN and ductal adenocarcinoma than previously appreciated. These findings have important implications for molecular risk stratification of patients with IPMN. ER -