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Zystische Pankreastumoren: Diagnostik und neue Biomarker

Cystic pancreatic tumors: diagnostics and new biomarkers

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Zusammenfassung

Das duktale Adenokarzinom des Pankreas (PDAC) wird bei der krebsbedingten Sterblichkeit in Zukunft noch weiter zunehmen. Die einzige kurative Therapie ist die radikale Resektion, wobei selbst bei kleinen Karzinomen bereits eine (Mikro‑)Metastasierung vorliegt, was die hohe Rate an Frührezidiven bei dieser Erkrankung erklärt. Dementsprechend wichtig ist die Detektion prämaligner Veränderungen. Im Wesentlichen entsteht das PDAC aus 3 Vorläuferläsionen, den pankreatischen intraepithelialen Läsionen (PanIN), den intraduktalen papillär-muzinösen Neoplasien (IPMN) und den muzinös-zystischen Neoplasien (MCN). Letztere bilden zusammen mit der serös-zystischen Neoplasie (SCN) und der solide pseudopapillären Neoplasie (SPN) die häufigsten zystischen Neoplasien im Pankreas. Demgegenüber stehen nichtneoplastische Läsionen. Schließt man die nichtneoplastischen Pseudozysten mit ein, erfassen die genannten Läsionen mehr als 90 % pankreatischer Zysten. Bei IPMN muss aufgrund des obligaten Ganganschlusses zwischen Haupt- und Seitengang-IPMN unterschieden werden. Diese Unterscheidung ist wichtig aufgrund der unterschiedlichen Entartungstendenz. Während Hauptgang-IPMN und MCN ein relativ hohes malignes Transformationsrisiko haben, zeigen Seitengang-IPMN einen variableren Verlauf. Die Differenzialdiagnose zystischer Pankreasläsionen ist daher essenziell, allerdings mit konventioneller Bildgebung oft sehr schwierig. Wünschenswert wäre es daher, anhand der molekularen Unterschiede zystischer Pankreasläsionen neue Biomarker und Diagnosetools zu entwickeln. Ziel ist es einerseits die prämalignen zystischen von strikt benignen zystischen Läsionen sicher zu unterscheiden und andererseits die Transformation zum Malignom rechtzeitig erkennen zu können. Die vorliegende Arbeit versucht einen Überblick über die molekularen Grundlagen zystischer Pankreasläsionen als Basis für eine verbesserte Diagnostik und die Entwicklung neuer Biomarker zu geben.

Abstract

Mortality due to pancreatic ductal adenocarcinoma (PDAC) will increase in the near future. The only curative treatment for PDAC is radical resection; however, even small carcinomas exhibit micrometastases leading to early relapse. Accordingly, detection of premalignant precursor lesions is important. In essence, PDAC develops from three precursor lesions: pancreatic intraepithelial lesions (PanIN), intraductal papillary-mucinous neoplasia (IPMN) and mucinous-cystic neoplasia (MCN). Together with serous cystic neoplasia (SCN) and solid pseudopapillary neoplasia (SPN), these cystic lesions constitute the most common cystic neoplasms in the pancreas. In the case of IPMN, main and branch duct IPMN have to be differentiated because of a markedly different malignancy potential. While main duct IPMN and MCN have a high malignancy transformation rate, branch duct IPMNs are more variable with respect to malignant transformation. This shows that differential diagnosis of cystic lesions is important; however, this is often very difficult to accomplish using conventional imaging. Novel biomarkers and diagnostic tools based on the molecular differences of cystic pancreatic lesions could be helpful to differentiate these lesions and facilitate early diagnosis. The aim is to distinguish the premalignant cysts from strictly benign cystic lesions and a timely detection of malignant transformation. This article provides an overview on the molecular characteristics of cystic pancreatic lesions as a basis for improved diagnostics and the development of new biomarkers.

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Authors and Affiliations

  1. Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    A. W. Berger,  T. Seufferlein &  A. Kleger

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  1. A. W. Berger
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  2. T. Seufferlein
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  3. A. Kleger
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Correspondence to T. Seufferlein or A. Kleger.

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A. W. Berger, T. Seufferlein und A. Kleger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Berger, A.W., Seufferlein, T. & Kleger, A. Zystische Pankreastumoren: Diagnostik und neue Biomarker. Chirurg 88, 905–912 (2017). https://doi.org/10.1007/s00104-017-0493-1

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