Volume 142, Issue 4, Pages (April 2012)

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Volume 142, Issue 4, Pages 796-804 (April 2012) Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals Marcia Irene Canto, Ralph H. Hruban, Elliot K. Fishman, Ihab R. Kamel, Richard Schulick, Zhe Zhang, Mark Topazian, Naoki Takahashi, Joel Fletcher, Gloria Petersen, Alison P. Klein, Jennifer Axilbund, Constance Griffin, Sapna Syngal, John R. Saltzman, Koenraad J. Mortele, Jeffrey Lee, Eric Tamm, Raghunandan Vikram, Priya Bhosale, Daniel Margolis, James Farrell, Michael Goggins Gastroenterology Volume 142, Issue 4, Pages 796-804 (April 2012) DOI: 10.1053/j.gastro.2012.01.005 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Study schema. BRCA, breast-related cancer; CP, chronic pancreatitis; MPD, main pancreatic duct; SD, standard deviation. Gastroenterology 2012 142, 796-804DOI: (10.1053/j.gastro.2012.01.005) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Asymptomatic prevalent combined (main duct and multiple branch duct) IPMNs in a 74-year-old healthy Ashkenazi Jewish woman with 2 affected first-degree relatives; pancreatic protocol CT (3A, right image), MRI/MRCP (2A, left image), and EUS (2B, right image) all showed multiple pancreatic cysts 3–15 mm (arrows indicate suspected BD-IPMNs) and a mildly dilated main pancreatic duct up to 3.8 mm. Endoscopic examination of the ampulla at the time of EUS showed a patulous pancreatic duct orifice with active mucin extrusion (2B, left image). EUS also showed echogenic mucin and polypoid mural nodules in the main duct and multiple cysts typical of mixed IPMN (2B, right image, arrow). See video (online only). Gastroenterology 2012 142, 796-804DOI: (10.1053/j.gastro.2012.01.005) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 Histologic sections from the distal pancreatectomy performed on patient 1. (A) The main duct IPMN harbored high-grade dysplasia and the adjacent pancreatic parenchyma had (B) pancreatic intraepithelial with high-grade dysplasia (PanIN-3). Gastroenterology 2012 142, 796-804DOI: (10.1053/j.gastro.2012.01.005) Copyright © 2012 AGA Institute Terms and Conditions