DETECTION OF K-RAS POINT MUTATION AT CODON-12 IN PURE PANCREATIC-JUICE COLLECTED 3 YEARS AND 6 MONTHS BEFORE THE CLINICAL-DIAGNOSIS OF PANCREATIC-CANCER

We report herein a patient with K-ras point mutation at codon 12 that had been detected in pure pancreatic juice (PPJ) obtained 3 yr and 6 m onths before he was diagnosed with pancreatic cancer (PC), In this 73- yr-old man, PC was diagnosed by ERCP, which showed obstruction of the main pancreatic duct (MPD) at the borderline area between the body and tail of the pancreas, Distal pancreatosplenectomy was performed, and an advanced PC at the tail of the pancreas with a few metastatic nodul es in the liver was confirmed, Retrospectively, a K-ras point mutation at codon 12 from GGT (glycine) to GAT (aspartic acid) was detected in the PPJ collected endoscopically 3 yr and 6 months earlier, as well a s in the PPJ when PC was diagnosed and in the resected tumor tissue, R eevaluation of pancreatography from the ERCP performed at that time re vealed a very mild stenotic lesion of the MPD, speculated to be a PC a t a very early stage, at the body-tail border, but it was difficult to diagnose this lesion as a PC, based only on this morphological study, Accordingly, we believe that this is an interesting and valuable clin ical case, indicating that K-ras mutation can precede clinical evidenc e, and its determination in PPJ could be a useful genetic test calling for a careful and extensive clinical investigation for early detectio n of PC.