First described as a distinct entity in the early1980s (1), pancreatic ductal
neoplasms with mucinhypersecretion have been increasingly recognized.This motivated the World Health Organization(WHO) reclassification proposal in 1996 (2), which separated them from mucinous
cystic neoplasms.These
tumors are now (3) termed intraductal papillarymucinous
neoplasms (IPMN). Despite a burgeoningvolume of recent literature devoted to thiscondition, little is known of the pathogenesis ofIPMN,which is believed to constitute 10% of mucinproducingpancreatic
tumors and 1% of pancreaticcancers (4). IPMN presents diagnostic and therapeuticchallenges to the clinician because it representsa histologic spectrum of morphology, from thebenign
adenoma to invasive
carcinoma. The initialhistological and morphological features of IPMN oftenunderestimate its invasive potential (5), and may notaccurately predict survival. Conversely, it may oftenbe difficult to differentiate benign from malignantlesions (5-7). In the most advanced stages, when aninvasive
carcinoma is present, IPMN can be indistinguishablefrom common pancreatic ductal
cancer(PC), yet with aggressive surgical management, theprognosis for patients with IPMN is far better (6,7).The availability of a prognostic
indicator, independentfrom the pathological stage, may help to directtherapy.