Zusammenfassung
Zystische Pankreasveränderungen umfassen neoplastische und nichtneoplastische Läsionen. Unter ihnen sind 5 Entitäten wichtig – Pseudozysten, intraduktale papillär-muzinöse Neoplasien (IPMN), muzinös-zystische Neoplasien (MCN), serös-zystische Neoplasien (SCN) und solid-pseudopapilläre Neoplasien (SPN) –, da sie zusammen 95% aller zystischen Pankreasläsionen ausmachen. Serös-zystische und solid-pseudopapilläre Neoplasien haben ein sehr niedriges Malignitätsrisiko, intraduktale papillär-muzinöse und muzinös-zystische Neoplasien ein deutlich höheres, da aus ihnen duktale Adenokarzinome hervorgehen können. Weitere Unterscheidungsmerkmale der genannten Entitäten betreffen ihre Epidemiologie, Pathologie und Klinik. Unter Berücksichtigung dieser Kriterien ist in vielen Fällen eine präoperative Diagnose als Voraussetzung für eine adäquate Therapie möglich.
Abstract
Cystic changes of the pancreas comprise a large spectrum of neoplastic and non-neoplastic lesions. Among these are five entities, i.e. pseudocysts, intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN) and solid pseudopapillary neoplasms (SPN), which represent 95% of all cystic pancreatic lesions. While SCN and SPN have a good prognosis, IPMN and MCN have a high risk of malignancy as they are potential precursors of pancreatic ductal adenocarcinoma. The differential diagnosis between these five entities is based on epidemiology, pathology and clinical criteria. Consideration of these criteria allows in many cases a preoperative stratification that is the basis for an adequate therapy.
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Literatur
Adsay NV, Hasteh F, Cheng JD et al (2002) Lymphoepithelial cysts of the pancreas: a report of 12 cases and a review of the literature. Mod Pathol 15: 492–501
Basturk O, Coban I, Adsay NV (2009) Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 133: 423–438
Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system, 4. edn. International Agency for Research on Cancer, Lyon
Brune K, Abe T, Canto M et al (2006) Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol 30: 1067–1076
Crippa S, Salvia R, Warshaw AL et al (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 247: 571–579
Furukawa T, Klöppel G, Volkan Adsay N et al (2005) Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch 447: 794–799
King JC, Ng TT, White SC, Cortina G, Reber HA, Hines OJ (2009) Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg 13: 1864–1868
Konukiewitz B, Enosawa T, Klöppel G (2011) Glucagon expression in cystic pancreatic neuroendocrine neoplasms: an immunohistochemical analysis. Virchows Arch 458: 47–53
Kosmahl M, Pauser U, Peters K, Sipos B, Lüttges J, Kremer B, Klöppel G (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: 168–178
Kosmahl M, Pauser U, Anlauf M, Klöppel G (2005) Pancreatic ductal adenocarcinomas with cystic features: neither rare nor uniform. Mod Pathol 18: 1157–1164
Lin MY, Stabile BE (2010) Solid pseudopapillary neoplasm of the pancreas: a rare and atypically aggressive disease among male patients. Am Surg 76: 1075–1078
Park WG, Chari ST (2010) Management of pancreatic cystic neoplasms: decision-making with limited information. Pancreatology 10: 142–143
Pauser U, Kosmahl M, Kruslin B, Klimstra DS, Klöppel G (2005) Pancreatic solid and cystic hamartoma in adults: characterization of a new tumorous lesion. Am J Surg Pathol 29: 797–800
Salimi J, Karbakhsh M, Dolatshahi S, Ahmadi SA (2004) Cystic teratoma of the pancreas: a case report. Ann Saudi Med 24: 206–209
Schnelldorfer T, Sarr MG, Nagorney DM et al (2008) Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch Surg 143: 639–646
Spinelli KS, Fromwiller TE, Daniel RA et al (2004) Cystic pancreatic neoplasms: observe or operate. Ann Surg 239: 651–657
Tanaka M (2011) Controversies in the management of pancreatic IPMN. Nat Rev Gastroenterol Hepatol 8: 56–60
Tanaka M, Chari S, Adsay V et al (2006) International Association of Pancreatology: International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6: 17–32
Tucci G, Muzi MG, Nigro C, Cadeddu F, Amabile D, Servadei F, Farinon AM (2007) Dermoid cyst of the pancreas: presentation and management. World J Surg Oncol 5: 85
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: 410–422%
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Klöppel, G., Schmid, R. Zystische Pankreasläsionen. Gastroenterologe 6, 515–523 (2011). https://doi.org/10.1007/s11377-011-0587-0
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DOI: https://doi.org/10.1007/s11377-011-0587-0
Schlüsselwörter
- Zystische Pankreasläsionen
- Intraduktale papillär-muzinöse Neoplasie
- Muzinös-zystische Neoplasie
- Serös-zystische Neoplasie
- Solid-pseudopapilläre Neoplasie