Yuko Omori1, Yusuke Ono2, Mishie Tanino3, Hidenori Karasaki4, Hiroshi Yamaguchi5, Toru Furukawa6, Katsuro Enomoto7, Jun Ueda8, Atsuko Sumi4, Jin Katayama9, Miho Muraki10, Kenzui Taniue11, Kuniyuki Takahashi12, Yoshiyasu Ambo13, Toshiya Shinohara14, Hiroshi Nishihara15, Junpei Sasajima2, Hiroyuki Maguchi12, Yusuke Mizukami16, Toshikatsu Okumura7, Shinya Tanaka3. 1. Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Pathology, Teine-Keijinkai Hospital, Sapporo, Japan. 2. Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan; Department of Medicine, Asahikawa Medical University, Asahikawa, Japan. 3. Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 4. Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan. 5. Division of Diagnostic Pathology, Tokyo Medical University, Tokyo, Japan. 6. Department of Histopathology, Tohoku University Graduate School of Medicine, Sendai, Japan. 7. Department of Medicine, Asahikawa Medical University, Asahikawa, Japan. 8. Center for Advanced Research and Education, Asahikawa Medical University, Asahikawa, Japan. 9. Diagnostic Partnering, Clinical Sequencing Division, Thermo Fisher Scientific, Tokyo, Japan. 10. Genomedia Inc., Tokyo, Japan. 11. Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan; Genomedia Inc., Tokyo, Japan. 12. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. 13. Department of Surgery, Teine-Keijinkai Hospital, Sapporo, Japan. 14. Department of Pathology, Teine-Keijinkai Hospital, Sapporo, Japan. 15. Cancer Center, Keio University Hospital, Tokyo, Japan. 16. Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan; Department of Medicine, Asahikawa Medical University, Asahikawa, Japan. Electronic address: ymizu_ccbr@higashi-tokushukai.or.jp.
Abstract
BACKGROUND & AIMS: Intraductal papillary mucinous neoplasms (IPMNs) are regarded as precursors of pancreatic ductal adenocarcinomas (PDAs), but little is known about the mechanism of progression. This makes it challenging to assess cancer risk in patients with IPMNs. We investigated associations of IPMNs with concurrent PDAs by genetic and histologic analyses. METHODS: We obtained 30 pancreatic tissues with concurrent PDAs and IPMNs, and 168 lesions, including incipient foci, were mapped, microdissected, and analyzed for mutations in 18 pancreatic cancer-associated genes and expression of tumor suppressors. RESULTS: We determined the clonal relatedness of lesions, based on driver mutations shared by PDAs and concurrent IPMNs, and classified the lesions into 3 subtypes. Twelve PDAs contained driver mutations shared by all concurrent IPMNs, which we called the sequential subtype. This subset was characterized by less diversity in incipient foci with frequent GNAS mutations. Eleven PDAs contained some driver mutations that were shared with concurrent IPMNs, which we called the branch-off subtype. In this subtype, PDAs and IPMNs had identical KRAS mutations but different GNAS mutations, although the lesions were adjacent. Whole-exome sequencing and methylation analysis of these lesions indicated clonal origin with later divergence. Ten PDAs had driver mutations not found in concurrent IPMNs, called the de novo subtype. Expression profiles of TP53 and SMAD4 increased our ability to differentiate these subtypes compared with sequencing data alone. The branch-off and de novo subtypes had substantial heterogeneity among early clones, such as differences in KRAS mutations. Patients with PDAs of the branch-off subtype had a longer times of disease-free survival than patients with PDAs of the de novo or the sequential subtypes. CONCLUSIONS: Detailed histologic and genetic analysis of PDAs and concurrent IPMNs identified 3 different pathways by which IPMNs progress to PDAs-we call these the sequential, branch-off, and de novo subtypes. Subtypes might be associated with clinical and pathologic features and be used to select surveillance programs for patients with IPMNs.
BACKGROUND & AIMS: Intraductal papillary mucinous neoplasms (IPMNs) are regarded as precursors of pancreatic ductal adenocarcinomas (PDAs), but little is known about the mechanism of progression. This makes it challenging to assess cancer risk in patients with IPMNs. We investigated associations of IPMNs with concurrent PDAs by genetic and histologic analyses. METHODS: We obtained 30 pancreatic tissues with concurrent PDAs and IPMNs, and 168 lesions, including incipient foci, were mapped, microdissected, and analyzed for mutations in 18 pancreatic cancer-associated genes and expression of tumor suppressors. RESULTS: We determined the clonal relatedness of lesions, based on driver mutations shared by PDAs and concurrent IPMNs, and classified the lesions into 3 subtypes. Twelve PDAs contained driver mutations shared by all concurrent IPMNs, which we called the sequential subtype. This subset was characterized by less diversity in incipient foci with frequent GNAS mutations. Eleven PDAs contained some driver mutations that were shared with concurrent IPMNs, which we called the branch-off subtype. In this subtype, PDAs and IPMNs had identical KRAS mutations but different GNAS mutations, although the lesions were adjacent. Whole-exome sequencing and methylation analysis of these lesions indicated clonal origin with later divergence. Ten PDAs had driver mutations not found in concurrent IPMNs, called the de novo subtype. Expression profiles of TP53 and SMAD4 increased our ability to differentiate these subtypes compared with sequencing data alone. The branch-off and de novo subtypes had substantial heterogeneity among early clones, such as differences in KRAS mutations. Patients with PDAs of the branch-off subtype had a longer times of disease-free survival than patients with PDAs of the de novo or the sequential subtypes. CONCLUSIONS: Detailed histologic and genetic analysis of PDAs and concurrent IPMNs identified 3 different pathways by which IPMNs progress to PDAs-we call these the sequential, branch-off, and de novo subtypes. Subtypes might be associated with clinical and pathologic features and be used to select surveillance programs for patients with IPMNs.
Authors: Catherine G Fischer; Violeta Beleva Guthrie; Alicia M Braxton; Lily Zheng; Pei Wang; Qianqian Song; James F Griffin; Peter E Chianchiano; Waki Hosoda; Noushin Niknafs; Simeon Springer; Marco Dal Molin; David Masica; Robert B Scharpf; Elizabeth D Thompson; Jin He; Christopher L Wolfgang; Ralph H Hruban; Nicholas J Roberts; Anne Marie Lennon; Yuchen Jiao; Rachel Karchin; Laura D Wood Journal: Gastroenterology Date: 2019-06-05 Impact factor: 22.682
Authors: Elizabeth D Thompson; Nicholas J Roberts; Laura D Wood; James R Eshleman; Michael G Goggins; Scott E Kern; Alison P Klein; Ralph H Hruban Journal: Mod Pathol Date: 2020-07-23 Impact factor: 7.842
Authors: Kohei Fujikura; Waki Hosoda; Matthäus Felsenstein; Qianqian Song; Johannes G Reiter; Lily Zheng; Violeta Beleva Guthrie; Natalia Rincon; Marco Dal Molin; Jonathan Dudley; Joshua D Cohen; Pei Wang; Catherine G Fischer; Alicia M Braxton; Michaël Noë; Martine Jongepier; Carlos Fernández-Del Castillo; Mari Mino-Kenudson; C Max Schmidt; Michele T Yip-Schneider; Rita T Lawlor; Roberto Salvia; Nicholas J Roberts; Elizabeth D Thompson; Rachel Karchin; Anne Marie Lennon; Yuchen Jiao; Laura D Wood Journal: Gut Date: 2020-10-07 Impact factor: 23.059