# IPMNs with co-occurring invasive cancers: neighbours but not always relatives

Source: https://onco.cc/key-papers/paper-felsenstein-ipmn-cooccurring-cancer-relatedness-gut-2018/  
OnCo record `paper-felsenstein-ipmn-cooccurring-cancer-relatedness-gut-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 61 patients who had both a cyst and a pancreatic cancer removed, the two were genetically related in about half and unrelated in a fifth, so a cyst can be an innocent bystander to a cancer arising elsewhere.

## Summary

All available patients with co-occurring IPMN and invasive intrapancreatic carcinoma over ten years at a single institution were analysed: DNA from the carcinoma, adjacent IPMN and distant IPMN underwent targeted next-generation sequencing of pancreatic cancer driver genes to infer relatedness. Of 61 patients with IPMN and ductal adenocarcinoma, 51% were likely related and 18% likely independent; all 13 IPMN and colloid carcinoma pairs were likely related. Striking genetic heterogeneity was found within IPMNs even for well-characterised driver genes.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Gut
- Year: 2018
- DOI: 10.1136/gutjnl-2017-315062
- Authors: Felsenstein M, Noe M, Masica DL, et al.
- Findings: Of 61 IPMN and ductal adenocarcinoma pairs, 51% likely related and 18% likely independent.; All 13 colloid carcinomas were related to their IPMN.
- What it means: Risk stratification of a cyst cannot assume the nearby cancer came from it, and the whole gland stays at risk after cyst resection.
- Caveats: Single institution; relatedness inferred from a driver-gene panel.; Heterogeneity within IPMNs can misclassify relatedness.

## Sources

- Felsenstein et al., Gut 2018: IPMNs with co-occurring invasive cancers, related in 51% and independent in 18%: https://doi.org/10.1136/gutjnl-2017-315062
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29500184/

## Connected records

- cancers: [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- targets: [GNAS](https://onco.cc/targets/gnas/), [KRAS](https://onco.cc/targets/kras/), [RNF43](https://onco.cc/targets/rnf43/), [SMAD4](https://onco.cc/targets/smad4/), [TP53](https://onco.cc/targets/tp53/)
- institutions: [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/)
- pathways: [Clonal evolution & minimal residual disease](https://onco.cc/pathways/clonal-evolution/)
- journals: [Gut](https://onco.cc/journals/gut/)

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