Table 1.
Characteristics of the cases from whom the pancreatic juice was obtained.
Table 2.
Characteristics of the cases from whom the pancreatic resected tissues were obtained.
Figure 1.
Genetic mutations in pure pancreatic juice.
The y-axis of the figure represents the percentage of cases with mutations in each gene. A. No mutation was detected in the pure pancreatic juice from cases with normal pancreas tissue. B. GNAS mutation was detected in one case (4.5%) with CP (chronic pancreatitis) and a small cystic lesion. C. GNAS and KRAS mutations were detected in 7.7% (three of 39 cases) and 20.5% (eight of 39 cases), respectively, that had pancreatic ductal adenocarcinoma (PDAC). The GNAS mutation was detected in all cases with intraductal papillary mucinous neoplasm (IPMN, n = 3). D. GNAS and KRAS mutations were detected in 41.5% (34 of 82 cases) and 39.0% (32 of 82 cases), respectively, with IPMN.
Figure 2.
Genetic mutations in resected tissues.
The y-axis of the figure represents the percentage of cases with mutations in each gene. A. In the resected tissue, the KRAS mutation was detected in 84.6% (22 of 26 cases) of the pancreatic ductal adenocarcinoma (PDAC) cases that did not have intraductal papillary mucinous neoplasm (IPMN). B. KRAS and GNAS mutations were detected in 80% (eight of 10 cases) and 50% (five of 10 cases), respectively, of PDAC cases concomitant with IPMN. C. KRAS and GNAS mutations were detected in 66.7% (four of 6 cases) and 33.3% (two of 6 cases), respectively, of PDAC cases derived from IPMN. D. KRAS and GNAS mutations were detected in 100% (n = 6) and 66.7% (four of 6 cases), respectively, of noninvasive IPMN cases.
Figure 3.
Radiological imaging of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN).
A. A case of CP with a small cyst (blue arrow) that had the GNAS mutation (Fig. 1B) in pure pancreatic juice on magnetic resonance cholangiopancreatography (MRCP) imaging. B–D. PDAC with GNAS mutations distinct from concomitant IPMN. In cases 30 (B) and 31 (C), MRCP imaging revealed stenosis in the MPD in the pancreatic head near the PDAC (yellow arrowhead). The IPMN was located in the pancreatic body (blue arrow). Computed tomographic imaging in case 28 (D) revealed that the PDAC was located in the pancreatic body (yellow arrowhead), whereas the IPMN was located in the pancreatic head (blue arrow). A list of cases B–D is shown in Table 4.
Table 3.
Results of univariate and multivariate analyses of GNAS status in the pancreatic juice of cases with IPMN.
Table 4.
Cancer-related gene profiling in resected pancreatic tumours.
Table 5.
Comparison of detected mutations between the pancreatic juice and resected tissue.
Figure 4.
Schema of pancreatic ductal adenocarcinoma (PDAC) with associated intraductal papillary mucinous neoplasm (IPMN).
A. The KRAS mutation was detected in ordinary PDAC without IPMN. B. KRAS and GNAS mutations were detected in IPMN. C. KRAS and GNAS mutations were detected in PDAC derived from primary IPMN. D. KRAS and GNAS mutations were detected not only in IPMN but also in PDAC that developed separately from IPMN.