LAUSR

mutations appear as an early event in the neoplastic transformation of IPMNs regarding almost half of the IPMN cases. Concerning those cases, it remains nevertheless unclear ifKRASmutations may give IPMNs as precursor lesions a malignant potential that impacts the maintenance of IPMN-associated PDAC. Our case presented KRAS mutations at codon 12 of the IPMN and activation of the KRAS oncogene has been detected in most PDACs. Because GNAS mutations are the most frequent mutations described in IPMNs and KRAS mutations, which occur principally in PDAC, exist in around half of the IPMN cases, the question raised is, if MDcIPMNs with identified KRAS mutations but absent GNASmutations share common pathways with PDAC. The ability to recognize IPMNs with “dangerous” molecular profiles might change the management of IPMNs. According to the revised international consensus guidelines, the surgical resection of mixed type IPMNs is recommended in surgically fit patients. For branch duct IPMNs, surgery is recommended when high-risk stigmata are present. However, accumulating data coming from surgical series observe a significantly different classification of IPMNs preoperatively and postoperatively. Fritz and colleagues demonstrated that main pancreatic involvement was present in the final histology in approximately 29% of the preoperatively suspected branch duct IPMNs. In such cases, the ability to recognize IPMNs with a dangerous molecular profile based on their molecular profile might modify the resection criteria for IPMNs.