MEDizzy - A 79-year-old woman belongs to a religious sect that follows

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The Pancreas

A 79-year-old woman belongs to a religious sect that follows the dictum “if it sounds like fun, you shouldn’t do it,” and has in so (not) doing avoided many risk factors for disease and remained healthy. For the past 7 months, she has had vague abdominal pain, however, and yesterday she experienced acute chest pain with dyspnea. Chest and abdomen CT scans show a pulmonary embolus. Her CT scan shows an irregular mass occupying most of the body and tail of the pancreas, along with hepatic metastases. Laboratory studies show an elevation in CEA and CA19-9. A mutation involving which of the following genes is most likely implicated in the development of this mass?

ExplanationMortality happens regardless. Prevalence for sporadic cancer (no identifiable inherited risks) increases with age. She has a pancreatic adenocarcinoma with Trousseau syndrome (a paraneoplastic hypercoagulable state) leading to pulmonary thromboembolism. The tumor markers CEA and CA19-9 are often present, but insensitive for early diagnosis of pancreatic cancer. KRAS mutations are found in more than 90% of pancreatic adenocarcinomas. APC gene mutations are associated with hereditary and sporadic forms of colonic adenocarcinoma. BRCA2 mutations are found in some pancreatic cancers, but usually there is a history of familial breast and ovarian cancers. CFTR mutations are associated with cystic fibrosis, which is not a risk for pancreatic cancer.