Omori Yuko, Furukawa Toru, Scarpa Aldo, Luchini Claudio
Department of Investigative Patholgy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy.
J Clin Pathol. 2023 Nov;76(11):734-739. doi: 10.1136/jcp-2023-209012. Epub 2023 Jul 27.
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is one of the most well-established precursors of pancreatic cancer. Its progression to acquire invasiveness is a complex process, based on the accumulation of morphological and genetic alterations. Recent advances in DNA sequencing also showed that co-occurring IPMNs and pancreatic cancers could be totally independent, further complicating our understanding of this complex scenario. The distinction between IPMN and related pancreatic cancer vs IPMN and co-occurring-but not related-pancreatic cancer is a challenging task in routine diagnostic activity, but may have important implications for precision oncology. Of note, recent multiregional sequencing-based studies focused not only on IPMN multi-step tumourigenesis, but also on the divergent intratumoural heterogeneity of this neoplasm. Globally considered, there are three different situations in which co-occurring IPMNs and invasive carcinomas can be found in the same pancreata, indicated with different terminologies: (1) IPMN-associated carcinoma: this definition indicates a carcinoma arising from an IPMN and can be also defined as IPMN-derived carcinoma, sequential or likely related; (2) independent IPMN and invasive carcinoma: the two lesions are not related, and this situation is defined as concomitant, de novo or likely independent; (3) branch-off pathway, where an invasive carcinoma and an adjacent IPMN develop divergently in a forked fashion from a common ancestral clone. In this review, we aim at clarifying the most important nomenclature/definitions of these different situations, also providing an overview of the molecular state-of-the-art and of the clinical implications of this complex landscape.
胰腺导管内乳头状黏液性肿瘤（IPMN）是胰腺癌最明确的前体病变之一。其向侵袭性发展是一个复杂的过程，基于形态学和基因改变的积累。DNA测序的最新进展还表明，同时存在的IPMN和胰腺癌可能完全独立，这进一步加深了我们对这一复杂情况的理解。在常规诊断活动中，区分IPMN与相关胰腺癌以及IPMN与同时存在但不相关的胰腺癌是一项具有挑战性的任务，但可能对精准肿瘤学具有重要意义。值得注意的是，最近基于多区域测序的研究不仅关注IPMN的多步骤肿瘤发生，还关注该肿瘤不同的肿瘤内异质性。总体而言，在同一胰腺中发现同时存在的IPMN和浸润性癌有三种不同情况，用不同术语表示：（1）IPMN相关癌：该定义指起源于IPMN的癌，也可定义为IPMN衍生癌，连续或可能相关；（2）独立的IPMN和浸润性癌：这两种病变不相关，这种情况定义为伴随、新发或可能独立；（3）分支途径，即浸润性癌和相邻的IPMN从一个共同的祖先克隆以分叉方式不同地发展。在本综述中，我们旨在阐明这些不同情况的最重要命名法/定义，同时概述这一复杂情况的分子最新进展和临床意义。
