Gastrointest Interv.  2017 Mar;6(1):32-36. 10.18528/gii.170005.

An appraisal of pancreatic cyst fluid molecular markers

• Modi RM
• Pavurala R
• Krishna SG

• KMID: 2376910
• DOI: http://doi.org/10.18528/gii.170005

Abstract

Pancreatic malignancy is the third leading cause of cancer related death in the United States with limited viable screening options. By the end of this decade, cancers are poised to become the leading cause of death with pancreatic cancer projected to be the second leading cause of cancer related mortality. Pancreatic cystic lesions (PCLs) are found in approximately 5%-14% of patients due to the increased utilization of cross-sectional imaging, with approximately 8%-10% of pancreatic cancers originating as PCLs. Current screening guidelines have shown discrepancies between morphologic characteristics of PCLs and identifying advanced pancreatic disease. Molecular analysis has emerged as a novel technology to aid in adequate diagnosis and management decisions of PCLs. Mucinous cysts including intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms have similar oncogenic mutations including KRAS, TP53, SMAD4, PIK3CA, PTEN, or CKDN2A, while GNAS and RNF43 mutations are specific only to IPMNs. Serous cystadenomas have been associated with a loss of tumor suppressor gene VHL, while solid-psuedopapillary neoplasms have an oncogenic mutation CTNNB1. A specific molecular marker to diagnose existing high-grade dysplasia or impending malignant transformation is yet to be identified. Moving forward it is important to advance technology in isolating and identifying high-risk molecular markers from cyst fluid while considering their increased utilization in the evaluation of PCLs.

Keyword

Biological tumor marker; Cystadenoma, serous; Loss of heterozygosity; Neoplasms, cystic, mucinous, and serous; Pancreatic neoplasms

MeSH Terms

Biomarkers, Tumor
Cause of Death
Cyst Fluid
Cystadenoma, Serous
Diagnosis
Genes, Tumor Suppressor
Humans
Loss of Heterozygosity
Mass Screening
Mortality
Mucins
Neoplasms, Cystic, Mucinous, and Serous
Pancreatic Cyst*
Pancreatic Diseases
Pancreatic Neoplasms
United States
Biomarkers, Tumor
Mucins