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Zystische Tumoren des Pankreas

Cystic tumors of the pancreas

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Zusammenfassung

Pankreaszysten sind meist entzündlicher Genese. In den letzten Jahrzehnten wurden jedoch zunehmend häufiger zystische Neoplasien des Pankreas beobachtet und operiert. Etwa 90% der zystischen Neoplasien werden von vier Typen repräsentiert: serös-mikrozystisch (SCN), muzinös-zystisch (MCN), intraduktal papillär-muzinös (IPMN) und solid-pseudopapillär (SPN). Zur häufigsten zystischen Neoplasie hat sich heute die IPMN entwickelt. Morphologisch unterscheidet man den Hauptgangtyp vom Nebengangtyp. Diese Einteilung hat prognostische und damit auch therapeutische Relevanz. Während der Hauptgangtyp häufig maligne entartet und deshalb grundsätzlich eine Operationsindikation darstellt, sind vor allem kleine Nebengang-IPMN überwiegend gutartig. Immunhistologisch wurden vier Untergruppen definiert, die von unterschiedlicher prognostischer Bedeutung sind. Allerdings sind die Untergruppen präoperativ in der Regel nicht bekannt. Selbst die Abgrenzung entzündlicher von neoplastischen Zysten kann in Einzelfällen nahezu unmöglich sein. Eindeutige Operationsindikationen sind mechanische Verlegung (Ikterus, Magenausgangsstenose), große oder an Größe zunehmende Tumoren, Beschwerden sowie die Sekretion muzinöser Flüssigkeit aus der Papilla Vateri.

Abstract

Cysts of the pancreas most often develop after chronic or acute inflammation of the pancreas. Cystic neoplasia of the pancreas have been increasingly recognized in clinical practice and 90% are represented by four types: serous microcystic (SCN), mucinous cystic (MCN), intraductal papillary-mucinous (IPMN) and solid pseudopapillary (SPN) neoplasia. IPMN is the most common form nowadays and main duct and branch duct types can be differentiated by morphology. This classification is of prognostic and therapeutic relevance. While main duct IPMNs have a high risk of malignant progression and resection is therefore recommended, branch duct IPMNs have a much lower risk of harboring malignancy. Small branch duct IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance. Recently, it has become clear that IPMN constitutes a heterogeneous group with at least four subtypes. Their stratification reveals that the various subtypes of IPMN have different biological properties with different prognostic implications, but the subclassification is usually not known prior to surgery. Moreover, even differentiation between inflammatory and neoplastic cysts can be challenging. Clear indications for resection are local complications (jaundice or gastric outlet obstruction), large and increasing tumurs, symptoms or secretion of mucinous fluid from the papilla of Vater.

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  1. Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinik Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    R. Grützmann & H.-D. Saeger

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  2. H.-D. Saeger
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Correspondence to R. Grützmann.

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Grützmann, R., Saeger, HD. Zystische Tumoren des Pankreas. Chirurg 81, 755–769 (2010). https://doi.org/10.1007/s00104-009-1861-2

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