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Background  The epigenetic mechanism of tumorigenesis in pancreatic intraductal papillary mucinous neoplasm (IPMN) remains largely unknown. The aim of this study is to examine the role of enhancer of zeste homologue 2 (EZH2) alteration in pancreatic IPMN progression.    Methods  Fifty-four surgically resected pancreatic IPMN specimens, including a total of 181 lesions (normal duct in 48, adenoma in 50, borderline atypia in 53, carcinoma in situ (CIS) in 19, and invasive carcinoma in 11) were analyzed by immunohistochemical staining (EZH2, Ki-67, p27 Kip1 ). Using paraffin embedded sections, total RNA was successfully extracted from 20 IPMN lesions (borderline IPMN in 9, CIS in 6, invasive carcinoma in 5) and 7 pancreatic normal ducts, and then levels of  EZH2  and  p27 Kip1   mRNA were analyzed by real time PCR.    Results  In immunohistochemical analysis, cell proliferative activity revealed by Ki-67 positive nuclei was increased during IPMN progression (normal duct<adenoma<borderline atypia<CIS ≈ invasive carcinoma). EZH2 expression displayed a similar pattern (normal duct<adenoma<borderline atypia<CIS ≈ invasive carcinoma) with cell proliferative activity. EZH2 expression in malignant (CIS and invasive carcinoma) IPMNs was significantly higher than that in adenoma and borderline-atypia IPMNs. EZH2 expression level in IPMN lesions was positively correlated with the Ki-67 positive nuclear ratio ( p <0.0001). EZH2-positive cells in malignant IPMN did not express p27 Kip1 .  EZH2  mRNA expressions in malignant lesions were significantly higher than those in benign lesions ( p <0.0001). In contrast,  p27 Kip1   mRNA in malignant lesions was significantly decreased compared to those in benign lesion ( p <0.05), and there was an inverse correlation between  EZH2  and  p27 Kip1   mRNA levels ( p  = 0.0109).    Conclusion  EZH2 is associated with the accelerated cell proliferation and malignant step in pancreatic IPMN via the downregulation of p27 Kip1 .

EZH2 Is Associated with Malignant Behavior in Pancreatic IPMN via p27Kip1 Downregulation