Precursor lesions for sporadic pancreatic cancer: PanIN, IPMN, and MCN

Abstract

Pancreatic cancer is still a dismal disease. The high mortality rate is mainly caused by the lack of highly sensitive and specific diagnostic tools, and most of the patients are diagnosed in an advanced and incurable stage. Knowledge about precursor lesions for pancreatic cancer has grown significantly over the last decade, and nowadays we know that mainly three lesions (PanIN, and IPMN, MCN) are responsible for the development of pancreatic cancer. The early detection of these lesions is still challenging but provides the chance to cure patients before they might get an invasive pancreatic carcinoma. This paper focuses on PanIN, IPMN, and MCN lesions and reviews the current level of knowledge and clinical measures.

Figure 1

Model of three distinct morphological pathways to invasive pancreatic carcinoma.

Figure 2

Compendium of molecular changes during the PanIN-progression model. Adapted from [6, 18].

Figure 3

(a) PanIN 1A lesion with flat epithelium, basal nuclei, and abundant supranuclear mucin. (b) PanIN 1A and 1B (arrow) lesion with papillary architecture and slight nuclear atypia (H&E ×20).

Figure 4

(a) PanIN-2 lesion with moderate cytological atypia, retained nuclear polarity, and partially papillary architecture (H&E, 20x); (b) PanIN-3 lesion with severe cytological atypia, lost nuclear polarity, and papillary architecture (H&E, 40x).

Figure 5

(a) and (b) IPMN gastric foveolar (branch duct) subtype with low-grade dysplasia, partially flat, partially papillary architecture, and basally oriented nuclei ((a); H&E 20x, (b); MUC5AC 20x); (c) and (d) IPMN intestinal subtype with low/intermediate dysplasia, long, finger-like papillae, and elongated nuclei ((c); H&E 4x, (b); MUC2 10x); (e) and (f) IPMN pancreatobiliary subtype with high-grade dysplasia, lost nuclear orientation, and complex papillae formation ((e); H&E 20x, (f); MUC1 20x).

Figure 6

(a) Overview of a multicystic MCN (H&E 2x) with cuboidal to columnar epithelial lining, mild dysplasia, and underlying ovarian type stroma. (b) High power view of MCN with columnar epithelial lining and underlying ovarian type stroma (H&E 40x).