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Zystische Läsionen des Pankreas

Cystic lesions of the pancreas

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Zusammenfassung

□ Die überwiegende Anzahl zystischer Läsionen des Pankreas sind Pseudozysten, die sich im Rahmen einer akuten oder chronischen Pankreatitis entwickeln. Kongenitale Zysten sind selten und werden oft zusammen mit kongenitalen Syndromen (zum Beispiel Von-Hippel-Lindau-Syndrom) beobachtet. Zystische Tumoren sind in der klinischen Präsentation oft nicht von diesen Entitäten zu unterscheiden. Eine sichere Diagnosestellung ist aber aufgrund der potentiellen Malignität der zystischen Tumoren, insbesondere der muzinbildenden Subtypen, wesentlich.

□ Bei allen zystischen Läsionen des Pankreas, deren Genese nicht im Zusammenhang mit einer ätiologisch geklärten akuten oder chronischen Pankreatitis steht, muß differentialdiagnostisch an zystische Tumoren gedacht werden. Trotz Sonographie, Computertomographie, endoskopischer retrograder Cholangiopankreatographie sowie Serumuntersuchungen kann die Abgrenzung dieser Entitäten schwierig sein. Endosonographie, Kernspintomographie und Analyse des Zystenpunktats können hierzu wichtige differentialdiagnostische Hinweise geben.

□ Die Therapie von Pseudozysten ist gut etabliert und orientiert sich an klinischer Symptomatik und Komplikationen. Gesicherte zystische Tumoren, aber auch bei begründetem Verdacht, müssen vollständig operativ reseziert werden.

□ Schlußfolgerung Bei allen zystischen Läsionen des Pankreas mit atypischer Präsentation muß differentialdiagnostisch an zystische Tumoren gedacht werden. Sofern die Diagnostik den Verdacht erhärtet, ist aufgrund der potentiellen Malignität dieser Läsionen eine vollständige Resektion indiziert.

Abstract

□ Most cystic lesions of the pancreas are pseudocysts caused by acute or chronic pancreatitis. Congenital cysts are rare and may occur in congenital syndromes like von Hippel-Lindau syndrome. Cystic tumors of the pancreas may be difficult to distinguish clinically; however, because of their malignant potential, in particular in cases of mucinous types, diagnostic verification is crucial.

□ Hence, in all cases of cystic lesions of the pancreas, which are not a sequela of an etiological confirmed acute or chronic pancreatitis, a cystic neoplasm must be ruled out. Differential diagnosis may be difficult even with ultrasonography, computertomography, endoscopic retrograde cholangiopancreatography and serum analyses; endoscopic ultrasound, magnetic resonance tomography and analysis of the cyst content may be of particular value.

□ The therapeutic approach for pseudocysts is now well established and guided by symptoms and complications. If a cystic neoplasm is suspected, surgical resection of the complete lesion is warranted.

□ Conclusion: The most important differential diagnosis in all cystic lesions of the pancreas with atypical presentation includes a cystic neoplasm. Therefore complete resection is indicated whenever the suspicion cannot be ruled out.

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  1. Abteilung für Innere Medizin, Israelisches Krankenhaus, Orchideenstieg 14, D-22297, Hamburg, Deutschland

    Ulrich Rosien & Peter Layer

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Correspondence to Ulrich Rosien.

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Rosien, U., Layer, P. Zystische Läsionen des Pankreas. Med Klin 94, 377–385 (1999). https://doi.org/10.1007/BF03044902

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