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• W1967142007 abstract "To the Editor: The recent study by Kaino et al. (1) examined mutations of the K-ras oncogene and the p53 tumor suppressor gene in pancreatic juice of intraductal papillary mucinous tumor (IPMT) using polymerase chain reaction single-strand conformation polymorphism analysis and direct sequencing. Then they compared the gene mutation in the pancreatic juice with the gene mutation and immunohistochemical overexpression in the resected specimens. They showed that mutation of p53 as well as K-ras was detected in both adenomas and carcinomas in comparable frequency and speculated that p53 mutation may occur at an early stage of the neoplastic process in at least some IPMT. They finally conclude that genetic analysis of K-ras and p53 in pancreatic juice can be useful for the clinical diagnosis of IPMT before surgery. This is an excellent study; however, we have some questions regarding their data. Although the genetic analysis of pancreatic juice corresponds to that of pancreatic tissue (1), the occurrence rates of mutation/overexpression of p53 in adenoma of IPMT seem higher than previous studies (2–4). Whereas the present study shows the mutation/overexpression rates in the pancreatic tissue as 50 and 25%, respectively, other similar studies show those rates in either pancreatic tissue or duct brush cytology specimens as 0%(2–4) (Table 1). Interestingly, the mutation rates of adenoma are higher than those of carcinoma (adenoma 50% > carcinoma 38% in the juice, adenoma 50% > carcinoma 43% in the tissue). This is not consistent with other similar studies (2–4) (Table 1). Other genetic analysis studies examining pancreatic ductal adenocarcinoma also show that the mutation/overexpression of p53 is seen frequently in malignant lesions and conclude that mutation of p53 is a relatively late event in carcinogenesis of pancreatic cancer (6–8). There is no comment regarding this discrepancy in the text.TABLE 1: p53 gene mutation/overexpression in intraductal papillary mucinous tumors (IPMT)Furthermore, another diagnosis might be possible from the Fig. 4 photomicrographs (1). Looking at Fig. 4A, the gland is lined by tall columnar cells containing round to oval nuclei in the basal portion, which could be consistent with adenoma rather than adenocarcinoma (5). This figure is presented as an example of adenocarcinoma in which diffuse overexpression of p53 is observed. On the other hand, looking at Fig. 4B, dysplasia is more severe, which could be consistent with adenocarcinoma rather than adenoma (5). This figure is presented as an example of adenoma in which focal overexpression of p53 is observed. If the diagnosis of the two cases in Fig. 4 is as we propose, the mutation rates will be different as follows: adenoma 25% < carcinoma 50% in the juice, adenoma 25% < carcinoma 57% in the tissue, which is consistent with previous studies (2–4,6–8). Hiroshi Usui Taiichi Otani" @default.
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• W1967142007 date "2001-01-01" @default.
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• W1967142007 title "Detection of K-ras and p53 Gene Mutations in Pancreatic Juice for the Diagnosis of Intraductal Papillary Mucinous Tumors" @default.
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• W1967142007 doi "https://doi.org/10.1097/00006676-200101000-00021" @default.
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