Abstract
Background: We present a case of adenocarcinoma arising in the oncocytic subtype of intraductal papillary mucinous neoplasm (O-IPMN), with emphasis on the molecular findings in the adenocarcinoma component. Tissue microdissection and next-generation sequencing were performed using a 26 gene panel (AKT1, ALK, APC, BRAF, CDH1, CTNNB1, EGFR, ERBB2, FBXW7, FGFR2, FOXL2, GNAQ, GNAS, KIT, KRAS, MAP2K1, MET, MSH6, NRAS, PDGFRA, PIK3CA, PTEN, SMAD4, SRC, STK11, TP53) of cancer-related genes.Case Presentation: A 69-year-old Caucasian female presented with chest pain and was found to have findings consistent with acute pancreatitis. During her work-up, computed tomography scan revealed a large cystic and solid mass in the tail of the pancreas. She recovered from her acute pancreatitis and was discharged home. She later returned for resection of her mass.Results: Evaluation of three microdissected regions of tumor demonstrated no identifiable nonsynonymous alterations in any of the three regions, within the targeted genes.Conclusion: This case demonstrates that the O-IPMN is a molecularly distinct subtype, and we conclude that adenocarcinoma arising in these neoplasms shows molecularly distinct tumorigenesis from traditional pancreatic ductal adenocarcinoma. These differences may help explain the improved survival with invasive adenocarcinoma arising from these lesions compared with traditional ductal adenocarcinoma.
Highlights
Introduction and BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are a heterogeneous group of tumors
We present a unique case of a 69-year-old female with a high-grade signet ring cell carcinoma arising within an oncocytic IPMN (O-IPMN), with associated radiological studies, molecular testing, and a review of literature
Review The formerly named intraductal oncocytic papillary neoplasm (IOPN) is an exceedingly rare lesion that has been recently reclassified as an O-IPMN.[3]
Summary
Introduction and BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are a heterogeneous group of tumors. These tumors develop an associated low-grade invasive carcinoma that retains the oncocytic features. With the introduction of routine molecular genetic analysis, including next-generation sequencing (NGS), recent studies have shown that these lesions are, genetically distinct from
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