Research progress in molecular changes of intraductal papillary mucinous neoplasms
Pancreatic cystic neoplasms(PCN)is a group of heterogeneous cystic tumors,including intraductal pa-pillary mucinous neoplasms(IPMN),mucinous cystic neoplasms(MCN),serous cystic neoplasms(SCN)and other rare cystic lesions.Among them,IPMN is the most common.IPMN and MCN are both precancerous lesions.The clini-cal manifestations of IPMN are different,including abdominal pain,acute pancreatitis,jaundice,diabetes and so on.The risk factors include diabetes mellitus with a history of insulin use,chronic pancreatitis and family history of pancre-atic ductal carcinoma(PDAC).At present,the sensitivity and accuracy of commonly used examination methods,such as imaging and pathological examination,are not good.EUS-FNA sampling cyst fluid and targeted next generation gene sequencing(NGS)of the genetic material of exfoliated cyst wall epithelium can detect gene mutations with high accuracy and good specificity.KRAS and GNAS mutations can be found in almost all individuals with IPMN alone or together.Both of them affect HSL levels through GNAS-PKA-cAMP-SIK and KRAS-PI3K-PIP3-AKT pathways,and then in-fluence cell lipid metabolism,which may promote tumor initiation and maintenance,as well as invasion.In addition,RNF43 is also found in IPMNs,which is presumably related ubiquitin E3 ligase.SMAD4,TP53,PIK3CA,PTEN,KLF4 and CDKN2A can also be found occasionally,but most of them are related to high-grade abnormal lesions and ma-lignant progression.This paper described the common mutations of IPMN and their possible mechanisms.
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