{"entity":{"id":"paper-omori-ipmn-progression-pathways-gastroenterology-2019","kind":"paper","name":"Pathways of progression from intraductal papillary mucinous neoplasm to pancreatic ductal adenocarcinoma based on molecular features","aka":[],"tldr":"Mapping 168 microscopic lesions from 30 pancreata that held both a cyst and a cancer showed three different relationships: the cancer grew out of the cyst, branched off it early, or arose independently, and the branch-off patients lived longest without recurrence.","summary":"Thirty pancreatic tissues with concurrent ductal adenocarcinoma and IPMN yielded 168 mapped, microdissected lesions analysed for mutations in 18 pancreatic cancer genes and tumour suppressor expression. Twelve cancers shared driver mutations with all concurrent IPMNs (sequential subtype, less diverse incipient foci and frequent GNAS mutations); eleven shared some (branch-off subtype, identical KRAS but different GNAS mutations despite adjacency, with whole-exome and methylation analysis indicating clonal origin and later divergence); ten had drivers not found in the IPMNs (de novo subtype). TP53 and SMAD4 expression improved subtype discrimination. Branch-off patients had longer disease-free survival than de novo or sequential patients.","asOf":"2026-09-24","links":[{"label":"Omori et al., Gastroenterology 2019: sequential, branch-off and de novo pathways from IPMN to cancer","url":"https://doi.org/10.1053/j.gastro.2018.10.029"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30342036/"}],"tags":[],"related":[],"cancers":["pancreatic","ipmn-cystic-precursors"],"sections":[],"technologies":[],"targets":["kras","gnas","tp53","smad4"],"drugs":[],"companies":[],"institutions":[],"pathways":["clonal-evolution"],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["gastroenterology"],"dependsOn":[],"notes":[],"journal":"Gastroenterology","year":2019,"doi":"10.1053/j.gastro.2018.10.029","pmid":"30342036","authors":"Omori Y, Ono Y, Tanino M, et al.","paperType":"translational","findings":["Three IPMN-to-cancer pathways: sequential (12), branch-off (11), de novo (10).","Branch-off cancers had the longest disease-free survival."],"whatItMeans":"A cancer next to a cyst is not necessarily from the cyst, so removing the cyst does not always remove the risk, and surveillance must cover the whole gland.","caveats":["Thirty pancreata from one programme.","Subtype assignment needs extensive microdissection not available in practice."],"changedPractice":false,"participants":30},"route":"/key-papers/paper-omori-ipmn-progression-pathways-gastroenterology-2019/","neighbours":{"cancer":[{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"target":[{"id":"gnas","kind":"target","name":"GNAS","route":"/targets/gnas/"},{"id":"kras","kind":"target","name":"KRAS","route":"/targets/kras/"},{"id":"smad4","kind":"target","name":"SMAD4","route":"/targets/smad4/"},{"id":"tp53","kind":"target","name":"TP53","route":"/targets/tp53/"}],"pathway":[{"id":"clonal-evolution","kind":"pathway","name":"Clonal evolution & minimal residual disease","route":"/pathways/clonal-evolution/"}],"journal":[{"id":"gastroenterology","kind":"journal","name":"Gastroenterology","route":"/journals/gastroenterology/"}]}}