Fig. 3

Clinicopathological course before and after recurrence in a representative patient with intraductal dissemination. Multiple recurrent tumors in the pancreatic head (arrowheads) emerging 0.9 years after resection of a mixed-type intraductal papillary mucinous neoplasm with massive mural nodules in the pancreatic tail (patient 7). Both primary and recurrent lesions harbored the KRAS G12V and CTNNB1 S37L mutations. The surgical margin was negative for neoplasia; however, a series of skip lesions marked by identical mutations in KRAS and CTNNB1 with intervening normal tissue in the branch pancreatic ducts was observed. Dashed line: surgical margin. Scale bars: 1 mm