{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:56:23Z","timestamp":1790646983520,"version":"4.1.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32CA282070"],"award-info":[{"award-number":["T32CA282070"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["U01 CA239522-01"],"award-info":[{"award-number":["U01 CA239522-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A molecular analysis of pancreatic cyst fluid is revolutionizing the clinical management of pancreatic cysts. Yet, there remains need for ongoing correlation of molecular testing with surgical pathology. An ~70-year old male was found to have focal main pancreatic duct dilation up to 7\u00a0mm at the pancreatic head\/neck on imaging without any discrete mass lesions. Duct fluid analysis found elevated carcinoembryonic antigen and decreased glucose level suggestive of intraductal papillary mucinous neoplasm (IPMN). Yet, molecular testing revealed no mutations. In the absence of a mass lesion, he was recommended surveillance. A year later, he had stable imaging and underwent repeat molecular testing, which revealed KRAS and GNAS mutations. He underwent pancreatoduodenectomy for suspected main duct IPMN. Final pathology revealed low-grade, multifocal pancreatic intraepithelial neoplasia, not IPMN. Ongoing assessment of concordance between molecular testing and postoperative pathology after pancreatectomy is needed to refine the multimodal diagnostic evaluation of pancreatic cysts.<\/jats:p>","DOI":"10.1093\/jscr\/rjag798","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:16:57Z","timestamp":1788520617000},"source":"Crossref","is-referenced-by-count":0,"title":["Discordant pathology following pancreatoduodenectomy for suspected intraductal papillary mucinous neoplasm: reassessment of cyst fluid genetic analysis"],"prefix":"10.1093","volume":"2026","author":[{"given":"Ella","family":"Sibbersen","sequence":"first","affiliation":[{"name":"Butler University, College of Liberal Arts and Sciences , Indianapolis, IN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhruv J","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biochemistry and Molecular Biology, Indiana University School of Medicine , Indianapolis, IN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassam A","family":"Cheema","sequence":"additional","affiliation":[{"name":"Department of Pathology, Indiana University School of Medicine , Indianapolis, IN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-5672","authenticated-orcid":false,"given":"Ralph H","family":"Hruban","sequence":"additional","affiliation":[{"name":"The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, MD ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Max","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biochemistry and Molecular Biology, Indiana University School of Medicine , Indianapolis, IN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092821054836700_ref1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1053\/j.gastro.2022.09.028","article-title":"Prospective, multi-institutional, real-time next-generation sequencing of pancreatic cyst fluid reveals diverse genomic alterations that improve the clinical management of pancreatic cysts","volume":"164","author":"Paniccia","year":"2023","journal-title":"Gastroenterology"},{"key":"2026092821054836700_ref2","doi-asserted-by":"publisher","first-page":"802","DOI":"10.2214\/AJR.07.3340","article-title":"Prevalence of unsuspected pancreatic cysts on MDCT","volume":"191","author":"Laffan","year":"2008","journal-title":"AJR Am J Roentgenol"},{"key":"2026092821054836700_ref3","doi-asserted-by":"publisher","first-page":"3684","DOI":"10.1007\/s00464-022-09854-y","article-title":"Dilatation of the main pancreatic duct of unknown origin: causes and risk factors of pre-malignancy or malignancy","volume":"37","author":"Martin","year":"2023","journal-title":"Surg Endosc"},{"key":"2026092821054836700_ref4","doi-asserted-by":"publisher","first-page":"e789","DOI":"10.1097\/SLA.0000000000005904","article-title":"A combined DNA\/RNA-based next-generation sequencing platform to improve the classification of pancreatic cysts and early detection of pancreatic cancer arising from pancreatic cysts","volume":"278","author":"Nikiforova","year":"2023","journal-title":"Ann Surg"},{"key":"2026092821054836700_ref5","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s00428-015-1751-6","article-title":"GNAS mutation is a frequent event in pancreatic intraductal papillary mucinous neoplasms and associated adenocarcinomas","volume":"466","author":"Hosoda","year":"2015","journal-title":"Virchows Arch"},{"key":"2026092821054836700_ref6","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1136\/gutjnl-2016-313586","article-title":"Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia","volume":"67","author":"Singhi","year":"2018","journal-title":"Gut"},{"key":"2026092821054836700_ref7","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aav4772","article-title":"A multimodality test to guide the management of patients with a pancreatic cyst","volume":"11","author":"Springer","year":"2019","journal-title":"Sci Transl Med"},{"key":"2026092821054836700_ref8","doi-asserted-by":"crossref","first-page":"92ra66","DOI":"10.1126\/scitranslmed.3002543","article-title":"Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development","volume":"3","author":"Wu","year":"2011","journal-title":"Science Transl Med"},{"key":"2026092821054836700_ref9","doi-asserted-by":"publisher","first-page":"8061","DOI":"10.3892\/mmr.2018.8875","article-title":"Intraductal papillary mucinous neoplasms of the pancreas: clinical association with KRAS","volume":"17","author":"Chang","year":"2018","journal-title":"Mol Med Rep"},{"key":"2026092821054836700_ref10","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1593\/neo.04445","article-title":"Frequency of K-ras mutations in pancreatic intraductal neoplasias associated with pancreatic ductal adenocarcinoma and chronic pancreatitis: a meta-analysis","volume":"7","author":"Lohr","year":"2005","journal-title":"Neoplasia"},{"key":"2026092821054836700_ref11","first-page":"581","article-title":"Differential expression of GNAS and KRAS mutations in pancreatic cysts","volume":"15","author":"Lee","year":"2014","journal-title":"JOP"},{"key":"2026092821054836700_ref12","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1097\/PAS.0000000000000117","article-title":"GNAS sequencing identifies IPMN-specific mutations in a subgroup of diminutive pancreatic cysts referred to as \u201cincipient IPMNs\u201d","volume":"38","author":"Matthaei","year":"2014","journal-title":"Am J Surg Pathol"},{"key":"2026092821054836700_ref13","doi-asserted-by":"publisher","first-page":"311","DOI":"10.4251\/wjgo.v6.i9.311","article-title":"Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas","volume":"6","author":"Castellano-Megias","year":"2014","journal-title":"World J Gastrointest Oncol"},{"key":"2026092821054836700_ref14","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1097\/PAS.0000000000002245","article-title":"PanIN or IPMN? Redefining lesion size in 3 dimensions","volume":"48","author":"Kiemen","year":"2024","journal-title":"Am J Surg Pathol"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/9\/rjag798\/71451369\/rjag798.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/9\/rjag798\/71451369\/rjag798.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:05:52Z","timestamp":1790643952000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag798\/8842682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":14,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag798","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,31]]},"article-number":"rjag798"}}