In this classification, the former PanIN III is considered high-grade PanIN, and its importance is due to the presented risks of malignancy.41 EUS-based FNA studies have enabled the preoperative identification of these lesions.8 These lesions express MUC1 and are associated with the markers of malignancy –including KRAS, telomere shortening, TP53, and CDKN2A.4 Currently, the only markers for differentiating BD-IPMNs from PanIN (and MCNs) are the intestinal markers, MUC2 and CD-X. Here, CDKN2A is linked to lipoid nephrosis.