Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 206-212, February 2010

Pathology Analysis Reveals That Dysplastic Pancreatic Ductal Lesions Are Frequent in Patients With Hereditary Pancreatitis

  • Vinciane Rebours

      Affiliations

    • Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie–Pancréatologie, Hôpital Beaujon, AP-HP, Paris, Clichy, France
    • Corresponding Author InformationReprint requests Address requests for reprints to: Vinciane Rebours, MD, Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy Cedex, France. fax: (33) 01-42-70-37-84
    • ,
  • Philippe Lévy

      Affiliations

    • Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie–Pancréatologie, Hôpital Beaujon, AP-HP, Paris, Clichy, France
    • ,
  • Jean–François Mosnier

      Affiliations

    • Service de Pathologie et de Cytologie, Hôpital Hôtel Dieu, Nantes, France
    • ,
  • Jean–Yves Scoazec

      Affiliations

    • Service de Pathologie, Hôpital Edouard Herriot, Lyon, France
    • ,
  • Marie–Sophie Soubeyrand

      Affiliations

    • Laboratoire de Pathologie, Lyon, France
    • ,
  • Jean–François Fléjou

      Affiliations

    • Service de Pathologie, Hôpital Saint-Antoine, AP-HP, Paris, France
    • ,
  • Bruno Turlin

      Affiliations

    • Service de Pathologie, Hôpital Pontchaillou, Rennes, France
    • ,
  • Pascal Hammel

      Affiliations

    • Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie–Pancréatologie, Hôpital Beaujon, AP-HP, Paris, Clichy, France
    • ,
  • Philippe Ruszniewski

      Affiliations

    • Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie–Pancréatologie, Hôpital Beaujon, AP-HP, Paris, Clichy, France
    • ,
  • Pierre Bedossa

      Affiliations

    • Service de Pathologie, Hôpital Beaujon, AP-HP, Inserm U773-CRB3, Paris, Clichy, France
    • ,
  • Anne Couvelard

      Affiliations

    • Service de Pathologie, Hôpital Beaujon, AP-HP, Inserm U773-CRB3, Paris, Clichy, France

published online 17 September 2009.

Background & Aims

Hereditary pancreatitis (HP) is a risk factor for pancreatic adenocarcinoma. We performed a retrospective, multicenter study to characterize and evaluate the frequency of pancreatic intraepithelial neoplasia (PanIN) and to describe the characteristics of fibrosis in pancreatic surgical specimens from patients with HP.

Methods

Samples from partial pancreatectomies (n = 13) of patients with HP complications (n = 12; 7 males; mean age, 24 y; 1 patient underwent 2 surgeries over 16 years) were analyzed by histologic and immunohistologic analyses; patients with suspected or proven pancreatic adenocarcinoma were excluded. HP diagnosis was confirmed by analysis of PRSS1 mutations. Dysplastic lesions were described according to the PanIN classification.

Results

Eleven patients were found to have the R122H mutation in PRSS1 and 1 patient was found to have the N29I mutation in PRSS1. Fifty-one PanIN lesions were observed in 10 specimens (77%): PanIN lesions 1a, 1b, 2, and 3 were observed in 8, 5, 8, and 5 specimens, respectively. The median number of PanIN lesions was 3.5 for each specimen. The density of the lesions was 2.6 per 10 cm2. The size of lesions was greater than 0.5 mm in 55% of the samples. Two patients with PanIN-3 developed pancreatic cancer, 18 months and 44 years after surgery.

Conclusions

PanIN lesions are frequent, severe, and occur early in the course of HP. Among patients with PanINs, 50% had PanIN-3 lesions. Pancreatectomy could be considered as a prophylactic against pancreatic cancer in patients with high-grade dysplasia.

Abbreviations used in this paper: HP, hereditary pancreatitis, PanIN, pancreatic intraepithelial neoplasia

 

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(09)00892-1

doi:10.1016/j.cgh.2009.09.009

Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 206-212, February 2010