Abstract
Background
Chronic pancreatitis (CP) found in the tropical countries is known to have a higher risk for carcinoma of the pancreas. This study aimed to explore the clinical profile of pancreatic intraepithelial neoplasia (PanIN), one of the precursors of carcinoma of the pancreas, in tropical CP and to identify the possible clinical predictors of the same.
Methodology
A retrospective study was done enrolling patients who underwent either Frey’s procedure or pancreatic resection for symptomatic CP, between January 2008 and December 2012. They were grouped into PanIN positive and PanIN negative based on histopathology. Their clinical and laboratory parameters were compared statistically to identify the predictors of the PanIN status.
Results
Sixty-two tropical CP patients who had Frey’s procedure or pancreatic resection were enrolled into this study; 38.7 % cases showed PanIN changes and 61.29 % had no PanIN changes. Majority of the clinical and laboratory parameters were found comparable between the two groups except obstructive jaundice and CA 19-9 value >137.5 which were there in 54.2 % of PanIN-positive cases. On histopathology, 54.83 % cases were benign CP and 45.16 % were malignant CP. Among the benign CP, 33.3 % were PanIN positive and among those with malignancy 66.7 % were PanIN positive. Low-grade PanINs were seen in 73 % cases of benign CP and in 26.1 % of malignancy whereas high-grade PanIN-3 lesions were seen exclusively in patients with malignancy.
Conclusion
High-grade PanIN-3 lesions showed significant association with pancreatic malignancy. Obstructive jaundice and CA 19-9 ≥137.5 could predict PanIN positivity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Farrow B, Evers BM. Inflammation and the development of pancreatic cancer. Surg Oncol. 2002;10:153–69.
Zuidema PJ. Cirrhosis and disseminated calcification of the pancreas in patients with malnutrition. Trop Geog Med. 1959;11:70–4.
Geevargheese PJ. Pancreatitis: Causes and Mechanisms in the Tropics Compared with those in the Subtropics. Trivandrum: St. Joseph’s Press; 1986. p. 67–75.
Pitchumoni CS. Chronic pancreatitis: a historical and clinical sketch of the pancreas and pancreatitis. Gastroenterologist. 1998;6:24–33.
Chari ST, Mohan V, Pitchumoni CS, et al. Risk of pancreatic cancer in tropical calcifying pancreatitis: an epidemiologic study. Pancreas. 1994;9:62–6.
Barman KK, Premalatha G, Mohan V, et al. Tropical chronic pancreatitis. Postgrad Med J. 2003;79:606–15.
Augustine P, Ramesh H. Is tropical pancreatitis premalignant? Am J Gastroenterol. 1992;87:1005–8.
Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223:273–9.
Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 2006;56:11–25.
Sipos B, Frank S, Gress T, et al. Pancreatic intraepithelial neoplasia revisited and updated. Pancreatology. 2009;9:45–54.
Konstantina D, Paraskeva. Diagnosis of early pancreatic cancer. Ann Gastroenterol. 2004;17:136–7.
Hisa T, Suda K, Nobukawa B, et al. Distribution of intraductal lesions in small invasive ductal carcinoma of the pancreas. Pancreatology. 2007;7:341–6.
Hruban RH, Adsay NV, Albores-Saavedra J, et al. Pancreatic intraepithelial neoplasia. A new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol. 2001;25:579–86.
Schwartz AM, Henson DE. Familial and sporadic pancreatic carcinoma, epidemiologic concordance. Am J Surg Pathol. 2007;31:645–6.
Andea A, Sarkar F, Adsay NV. Clinicopathological correlates of pancreatic intraepithelial neoplasia: a comparative analysis of 82 cases with and 152 cases without pancreatic ductal adenocarcinoma. Mod Pathol. 2003;16:996–1006.
Sommers SC, Murphy SA, Warren S. Pancreatic duct hyperplasia and cancer. Gastroenterology. 1954;27:629–40.
Klimstra DS, Longnecker DS. K-ras mutations in pancreatic ductal proliferative lesions. Am J Pathol. 1994;145:1547–8.
Hruban RH, Takaori K, Klimstra DS, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2001;28:977–87.
Tabata T, Fujimoro T, Maeda S, et al. The role of ras mutation in pancreatic cancer, precancerous lesions, and chronic pancreatitis. Int J Pancreatol. 1993;14:237–44.
Matthaei H, Hong SM, Mayo SC, et al. Presence of pancreatic intraepithelial neoplasia in the pancreatic transaction margin does not influence outcome in patients with R0 resected pancreatic cancer. Ann Surg Oncol. 2011;18:3493–9.
Misra SP, Thorat VK, Vij JC, et al. Development of carcinoma in chronic calcific pancreatitis. Int J Pancreatol. 1990;6:307–12.
Senthilkumar P, Ravichandran P, Sastha P, et al. Predictors of malignancy in chronic calcific pancreatitis with head mass. World J Gastrointest Surg. 2013;27:97–103.
Subhash R, Sindhu RS, Shabeerali TU, et al. Predictors of malignancy in pancreatic head mass in CCP—a clinicopathological correlative study. Pancreatology. 2011;11 Suppl 1:1–80.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
RSS, GP, KF, MKJ, SG, BK, BN, and RR confirm that they have no competing interests.
Ethics statement
The authors declare that the study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Rights and permissions
About this article
Cite this article
Sindhu, R.S., Parvathy, G., Fysal, K. et al. Clinical profile of PanIN lesions in tropical chronic pancreatitis. Indian J Gastroenterol 34, 436–441 (2015). https://doi.org/10.1007/s12664-015-0609-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-015-0609-9