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Klassifikation und malignes Potenzial der zystischen Pankreastumoren

Classification and malignant potential of pancreatic cystic tumors

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Zusammenfassung

Zystische Pankreastumoren nehmen zu. Bei 70-Jährigen liegt die Inzidenz inzwischen bei 10 %. Trotz ihres breiten Spektrums lässt sich die Mehrheit der resezierten Tumoren auf wenige Entitäten zurückführen: intraduktale papillär-muzinöse Neoplasien (IPMN), muzinös-zystische Neoplasien (MCN), serös-zystische Neoplasien (SCN), neuroendokrine zystische Tumoren (NECT) und solide pseudopapilläre Neoplasien (SPN). Das maligne Potenzial dieser Läsionen unterscheidet sich erheblich: IPMN und MCN sind Vorläuferläsionen des duktalen Adenokarzinoms des Pankreas, NECT und SPN sind potenziell maligne Neoplasien und SCN verhalten sich meist benigne. Aufgrund der nicht zu vernachlässigenden Morbidität- und Mortalitätsrate bei operativen Pankreaseingriffen, die auch in spezialisierten Zentren beobachtet wird, ist eine präoperative Stratifizierung in Tumoren mit niedrigem und hohem Malignitätspotenzial unerlässlich, um Risikoläsionen zu identifizieren, die umgehend reseziert werden sollten. Die Pathologie nimmt in diesem Prozess eine entscheidende Funktion in der präoperativen und postoperativen Diagnosestellung und -sicherung sowie der daraus resultierenden Behandlung und Nachsorge ein.

Abstract

Cystic lesions of the pancreas are increasingly diagnosed with a reported prevalence of 10 % in 70-year-old individuals. Despite their broad spectrum, most resected cystic lesions can be attributed to one of the following entities: intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN), neuroendocrine cystic tumors (NECT), and solid pseudopapillary neoplasms (SPN). Among them, IPMN and MCN represent precursors of ductal adenocarcinoma, NECT and SPN are low-grade, potentially malignant lesions, and SCN are usually benign. Due to the not negligible morbidity and mortality rates in pancreatic surgery, even in highly specialized centers, an interdisciplinary preoperative stratification of pancreatic cystic lesions into high- and low-risk tumors is necessary in order to accurately select those cases that need to undergo immediate resection. The role of the pathologist is fundamental in both the preoperative assessment and in the postoperative classification, which determines prognosis, further treatment, and follow-up.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. I. Esposito, A.M. Schlitter, B. Sipos und G. Klöppel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Institut für Pathologie und Pathologische Anatomie, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    I. Esposito, A.M. Schlitter & G. Klöppel

  2. Institut für Pathologie, Universität Tübingen, Tübingen, Deutschland

    B. Sipos

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Esposito, I., Schlitter, A., Sipos, B. et al. Klassifikation und malignes Potenzial der zystischen Pankreastumoren. Pathologe 36, 99–114 (2015). https://doi.org/10.1007/s00292-014-1971-6

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