Table 1.
Summary of Key Molecular Alternations in Pancreatic Cystic Lesions.
| Pancreatic Cystic Lesions | Molecular Alterations | |
|---|---|---|
| Most Common | Enriched in Advanced Neoplasia */Progression | |
| Mucinous Neoplastic Cysts | ||
| Intraductal papillary mucinous neoplasm (IPMN) |
KRAS, GNAS, KLF4, RNF43, (rare BRAF, EGFR, HER2) |
TP53, SMAD4, mTOR genes ** |
| Mucinous cystic neoplasm (MCN) | KRAS, RNF43 | TP53, SMAD4, mTOR genes ** |
| Intraductal oncocytic papillary neoplasm (IOPN) | Rearrangements in PRKACA and PRKACB; Mutations in ARHGAP26, ASXL1, EPHA8, ERBB4 |
|
| Intraductal tubulopapillary neoplasm (ITPN) *** | Chromatin remodeling genes (MLL1, MLL2, MLL3, BAP1); PI3K pathway genes (PIK3CA, PTEN) | |
| Non-Mucinous Neoplastic Cysts | ||
| Serous cystadenoma | VHL | TP53, TERT promoter mutations |
| Solid pseudopapillary neoplasm | CTNNB1 | |
| Cystic neuroendocrine tumor |
MEN1
VHL |
Loss of ATRX/DAXX; Alternative lengthening of telomeres; Loss of heterozygosity ≥ 3 genes |
* Advanced neoplasia = High-grade dysplasia and invasive carcinoma; ** mTOR genes include PTEN, PIK3CA, AKT1: *** ITPN is a mucin-poor neoplasm.