CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(12): E1454-E1461
DOI: 10.1055/a-0721-1747
Case report
Owner and Copyright © Georg Thieme Verlag KG 2018

Utility of “liquid biopsy” using pancreatic juice for early detection of pancreatic cancer

Tetsuhiro Okada*
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Hirotoshi Iwano*
3  Department of Gastroenterology and Endoscopic Unit, Shibetsu City Hospital, Shibetsu, Hokkaido 095-0048, Japan
,
Yusuke Ono
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Hidenori Karasaki
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
4  Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
,
Takayuki Sato
3  Department of Gastroenterology and Endoscopic Unit, Shibetsu City Hospital, Shibetsu, Hokkaido 095-0048, Japan
,
Masataka Yamada
3  Department of Gastroenterology and Endoscopic Unit, Shibetsu City Hospital, Shibetsu, Hokkaido 095-0048, Japan
,
Yuko Omori
5  Department of Histopathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan
,
Hiroki Sato
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Akihiro Hayashi
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Hidemasa Kawabata
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Takuma Goto
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Junpei Sasajima
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Shuhei Takauji
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Kazuo Nagashima
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
,
Yusuke Mizukami
1  Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
,
Toshikatsu Okumura
2  Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
› Author Affiliations
Further Information

Publication History

submitted 26 April 2018

accepted after revision 03 July 2018

Publication Date:
10 December 2018 (online)

  

Abstract

Background Despite advances in the diagnosis of pancreatic ductal adenocarcinoma (PDA), histological evaluation of small and poorly defined masses in the pancreas is uncomfortable and unsafe.

Methods We herein report a case of early stage PDA, in which multiple KRAS mutations were detected in the pancreatic juice preoperatively. A small hypoechoic area adjacent to the portal vein was detected through endoscopic ultrasound in the pancreatic body. KRAS mutations were evaluated using plasma, and the pancreatic juice by digital PCR.

Results Pancreatic duct biopsy and pancreatic juice cytology were performed with no evidence of malignancy; however, KRAS mutations, KRAS G12V and G12D, were detected in the pancreatic juice. Histological assessment of the resected specimen demonstrated a solid tumor with desmoplastic reaction accompanied by carcinoma in situ in the main pancreatic duct where KRAS G12V mutation was identified. More detailed analysis demonstrated KRAS G12D mutation in the cluster of low grade pancreatic intraepithelial neoplasia, implying that the lesion developed independently.

Conclusions Our study indicates the potential of “endoscopic liquid biopsy” to capture the driver gene for PDA diagnosis.

* These authors have contributed equally.