Advertisement

Der Radiologe

, 48:740 | Cite as

Zystische Tumoren des Pankreas

  • H.-J. Brambs
  • M. Juchems
Leitthema

Zusammenfassung

Zystische Pankreastumoren umfassen ein breites Spektrum gutartiger, prämaligner und maligner Veränderungen, die primär zystisch sind oder durch eine zystische Degeneration solider Tumoren entstehen. Wegen des breiten Einsatzes von Schnittbildtechniken werden sie zunehmend bei asymptomatischen Patienten und bei Patienten mit Bauchschmerzen, Pankreatitis und Ikterus entdeckt. Unter diesen Tumoren stellen die intraduktalen papillären muzinösen Neoplasien, die serösen zystischen Neoplasien und die muzinös zystischen Neoplasien den Hauptanteil. Mit zunehmender Erfahrung mit diesen Tumoren hat sich ein tieferes Verständnis für die Morphologie und den natürlichen Verlauf entwickelt. Es wird zunehmend gefordert, diese Tumoren zu differenzieren und ihre Dignität einzuschätzen, sodass eine genaue Kenntnis der morphologischen Zeichen in der CT und MRT wichtig ist. Da die Morphologie sehr vielgestaltig ist und sich die Phänomene überlappen können, sind zusätzliche Kriterien wie klinisches Bild, Lokalisation, Alter und Geschlecht mit in Betracht zu ziehen. Bei adäquater Therapie können die meisten Tumoren durch eine chirurgische Entfernung beseitigt werden. Das Management zystischer Tumoren ist bei asymptomatischen Patienten noch nicht standardisiert.

Schlüsselwörter

Zystische Pankreastumoren Computertomographie (CT) Magnetresonanztomographie (MRT) Differenzierung der unterschiedlichen Typen Unterscheidung gutartiger und maligner Formen Therapie und Management 

Cystic tumors of the pancreas

Abstract

Cystic lesions of the pancreas encompass a broad spectrum of benign, premalignant, and malignant tumors which are primarily cystic or result from cystic necroses of solid neoplasms. Because of the wide use of cross-sectional imaging techniques they are increasingly being identified in asymptomatic patients as well as in patients presenting with abdominal pain, jaundice or pancreatitis. Among these lesions, intraductal papillary mucinous neoplasms, serous cystic neoplasms and mucinous cystic neoplasms represent the majority of cases. With increasing experience with these tumors, a refinement of our understanding of their morphology and of their natural course has emerged. It is important to be familiar with the CT and MR imaging features of these lesions to differentiate these tumors and to orient the diagnosis towards benign or malignant forms. Because characterization of cystic tumors of the pancreas can sometimes be difficult due to overlapping imaging features, additional criteria such as clinical symptoms, localization, age and gender have to be taken into account. If appropriately treated, these tumors can usually be cured by resection and the decreasing risk of pancreatic surgery has led to an increasing number of resections of pancreatic tumors. The management of cystic tumors of the pancreas has not yet been standardized and the correct evaluation and subsequent management of the disease in asymptomatic patients have not been fully defined.

Keywords

Cystic pancreatic tumors Computed tomography (CT) Magnetic resonance imaging (MRI) Differentiation of various types Differentiation of benign and malignant forms Therapy and management 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Adler G, Seufferlein T, Bischoff SC et al. (2007) S3-Leitlinie Exokrines Pankreaskarzinom 2007. Ergebnis einer evidenzbasierten Konsensuskonferenz. Z Gastroenterol 45: 487–523PubMedCrossRefGoogle Scholar
  2. 2.
    Brugge WR, Lauwers GY, Sahani D et al. (2004) Cystic neoplasms of the pancreas. N Engl J Med 351: 1218–1226PubMedCrossRefGoogle Scholar
  3. 3.
    Brugge WL, Lewandrowski K, Lee-Lewandrowski E et al. (2004) Diagnosis of cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 126: 1330–1336PubMedCrossRefGoogle Scholar
  4. 4.
    Buetow PC, Buck IL, Pantongrag-Brown L et al. (1996) Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation in 56 cases. Radiology 199: 707–711PubMedGoogle Scholar
  5. 5.
    Cantisani V, Mortele KJ, Levy A et al. (2003) MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR 181: 395–401PubMedGoogle Scholar
  6. 6.
    Carbognin G, Pinali L, Girardi V et al. (2007) Collateral branches IPMTs: secretin-enhanced MRCP. Abdom Imaging 32: 374–380PubMedCrossRefGoogle Scholar
  7. 7.
    Chari S, Yadav D, Smyrk TC et al. (2002) Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 123: 1500–1507PubMedCrossRefGoogle Scholar
  8. 8.
    Choi MG, Kim SS, Han SS et al. (2006) High incidence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasms. Arch Surg 141: 51–56PubMedCrossRefGoogle Scholar
  9. 9.
    Christensen JA, Fletcher JG, Fidler JL et al. (2004) Intraductal papillary mucinous neoplasms of the pancreas: CT patterns of recurrence and multiobserver performance in detecting recurrent neoplasms. AJR 183: 1367–1374PubMedGoogle Scholar
  10. 10.
    Cohen-Scali F, Vilgrain V, Brancatelli G et al. (2003) Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations. Radiology 228: 727–733PubMedCrossRefGoogle Scholar
  11. 11.
    Crippa S, Salvia R, Warshaw AL et al. (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity. Ann Surg 247: 571–579PubMedCrossRefGoogle Scholar
  12. 12.
    Fernandez del-Castillo C, Targarono J, Thayer SP et al. (2003) Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138: 427–434CrossRefGoogle Scholar
  13. 13.
    Fukukura N, Fujiyoshi F, Sasaki M et al. (2000) Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings. AJR 174: 441–447PubMedGoogle Scholar
  14. 14.
    Fukukura Y, Fujiyoshi F, Hamada H et al. (2003) Intraductal papillary mucinous tumors of the pancreas. Comparison of helical CT and MR imaging. Acta Radiol 44: 464–471PubMedCrossRefGoogle Scholar
  15. 15.
    Goh BKP, Tan YM, Yap WM et al. (2006) Pancreatic serous oligocystic adenomas: clinicopathologic features and a comparison with serous microcystic adenomas and mucinous cystic neoplasms. World J Surg 30: 1553–1559PubMedCrossRefGoogle Scholar
  16. 16.
    Goh BK, Tan YM, Thong CH et al. (2008) How useful are clinical, biochemical, and cross-sectional imaging features in predicting potentially malignant or malignant cystic lesions of the pancreas? Results from a single institution experience with 220 surgically treated patients. J Am Coll Surg 206: 17–27PubMedCrossRefGoogle Scholar
  17. 17.
    Kawamoto S, Horton KM, Lawler LP et al. (2005) Intraductal papillary mucinous neoplasm of the pancreas: can benign lesions be differentiated from malignant lesions with multidetector CT? RadioGraphics 25: 1451–1470PubMedCrossRefGoogle Scholar
  18. 18.
    Kawamoto S, Lawler LP, Horton KM et al. (2006) MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma. AJR 186: 687–695PubMedCrossRefGoogle Scholar
  19. 19.
    Khurana B, Mortelé KJ, Glickman J et al. (2003) Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation. AJR 181: 119–123PubMedGoogle Scholar
  20. 20.
    Kim YH, Saini S, Sahani DV et al. (2005) Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. RadioGraphics 25: 671–685PubMedCrossRefGoogle Scholar
  21. 21.
    Kim SY, Lee JM, Kim SH et al. (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR 187: 1192–1198PubMedCrossRefGoogle Scholar
  22. 22.
    Kimura W, Sasahira N, Yoshikawa T et al. (1996) Duct-ectatic type of mucin producing tumor of the pancreas. New concept of pancreatic neoplasia. Hepatogastroenterology 43: 692–709PubMedGoogle Scholar
  23. 23.
    Kirkpatrick IDC, Desser TS, Nino-Murcia M, Brooke Jeffrey R (2007) Small cystic lesions of the pancreas: clinical significance and findings at follow-up. Abdom Imaging 32: 119–125PubMedCrossRefGoogle Scholar
  24. 24.
    Kosmahl M, Pauser U, Peters K et al. (2004) Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 445: 168–178PubMedCrossRefGoogle Scholar
  25. 25.
    Klöppel G, Solcia E, Longnecker DS et al. (1996) Histological typing of tumours of the exocrine pancreas. Springer, Berlin Heidelberg New YorkGoogle Scholar
  26. 26.
    Klöppel G (1998) Clinicipathologic view of intraductal papillary-mucinous tumor of the pancreas. Hepatogastroenterology 45: 1981–1985PubMedGoogle Scholar
  27. 27.
    Klöppel G, Kosmahl M (2001) Cystic lesions and neoplasms of the pancreas. Pancreatology 1: 648–655PubMedCrossRefGoogle Scholar
  28. 28.
    Longnecker DS, Adler G, Hruban RH et al. (2000) Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA (eds) World Health Organization: Classification of the Digestive System. IARC Press, Lyon, pp 237–241Google Scholar
  29. 29.
    Merkle EM, Weber CK, Siech M et al. (1996) Papillary cystic and solid tumor of the pancreas. Z Gastroenterol 34: 743–746PubMedGoogle Scholar
  30. 30.
    Nakatani K, Watanabe Y, Okumura A et al. (2007) MR imaging features of solid-pseudopapillary tumor of the pancreas. Magn Reson Med Sci 6: 121–126PubMedCrossRefGoogle Scholar
  31. 31.
    Pilleul F, Rochette A, Partensky C et al. (2005) Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 21: 237–244PubMedCrossRefGoogle Scholar
  32. 32.
    Suzuki Y, Atomi Y, Sugiyama M et al. (2004) Cystic neoplasm of the pancreas: a Japanese multiinstitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas 28: 241–246PubMedCrossRefGoogle Scholar
  33. 33.
    Sahani DV, Kadavigere R, Saokar A et al. (2005) Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. RadioGraphics 25: 1471–1484PubMedCrossRefGoogle Scholar
  34. 34.
    Sahani DV, Kadavigere R, Blake M et al. (2006) Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations-correlation with MRCP. Radiology 238: 560–569PubMedCrossRefGoogle Scholar
  35. 35.
    Sahani DV, Saokar A, Hahn PF (2006) Pancreatic cysts 3 cm or smaller: how aggressive should treatment be? Radiology 238: 912–919PubMedCrossRefGoogle Scholar
  36. 36.
    Sohn TA, Yeo CJ, Cameron JL et al. (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updates experience. Ann Surg 239: 788–799PubMedCrossRefGoogle Scholar
  37. 37.
    Takada A, Itoh S, Suzuki K et al. (2005) Branch duct-type intraductal papillary mucinous tumor: diagnostic value of multiplanar reformatted images in multislice CT. Eur Radiol 15: 1888–1897PubMedCrossRefGoogle Scholar
  38. 38.
    Tanaka M, Chari S, Adsay V et al. (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6: 17–32PubMedCrossRefGoogle Scholar
  39. 39.
    Tanno S, Nakano Y, Nishikawa T et al. (2007) Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 57: 339–343PubMedCrossRefGoogle Scholar
  40. 40.
    Taouli B, Vilgrain V, Vullierme MP (2000) Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathologic correlation. Radiology 217: 757–764PubMedGoogle Scholar
  41. 41.
    Thompson LD, Becker RC, Przygodzki RM et al. (1999) Mucinous cystic neoplasm (mucinous cystadenocarinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23: 1–16PubMedCrossRefGoogle Scholar
  42. 42.
    Visser BC, Yeh BM, Qayyum A et al. (2007) Characterization of cystic pancreatic masses: relative accuracy of CT and MRI. AJR 189: 648–656PubMedCrossRefGoogle Scholar
  43. 43.
    Vullierme MP, Giraud-Cohen M, Hammel P et al. (2007) Malignant intraductal papillary mucinous neoplasm of the pancreas: in situ versus invasive carcinoma – surgical resectability. Radiology 245: 483–490PubMedCrossRefGoogle Scholar
  44. 44.
    Zamboni G, Scarpa A, Bogina G et al. (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23: 410–422PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Abteilung für diagnostische und interventionelle RadiologieUniversitätsklinikum UlmUlmDeutschland

Personalised recommendations